Prophylactic cranial irradiation in small-cell lung cancer

Abstract

The publication of Toshiaki Takahashi and colleagues' study 1 Takahashi T Yamanaka T Seto T et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2017; 18: 663-671 Summary Full Text Full Text PDF PubMed Scopus (297) Google Scholar on the prognostic role of prophylactic cranial irradiation in patients with extensive-stage small-cell lung cancer who responded to initial chemotherapy has been highly anticipated. Unfortunately, the study could not confirm a survival benefit of prophylactic cranial irradiation compared with observation or previous results from the EORTC trial. 2 Slotman B Faivre-Finn C Kramer G et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. 2007; 357: 664-672 Crossref PubMed Scopus (854) Google Scholar Despite a reduction of metachronous brain failure (relapse or development of metastases) in the prophylactic cranial irradiation group, no transformation into survival benefit was achieved. 1 Takahashi T Yamanaka T Seto T et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2017; 18: 663-671 Summary Full Text Full Text PDF PubMed Scopus (297) Google Scholar Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trialIn this Japanese trial, prophylactic cranial irradiation did not result in longer overall survival compared with observation in patients with extensive-disease small-cell lung cancer. Prophylactic cranial irradiation is therefore not essential for patients with extensive-disease small-cell lung cancer with any response to initial chemotherapy and a confirmed absence of brain metastases when patients receive periodic MRI examination during follow-up. Full-Text PDF Prophylactic cranial irradiation in small-cell lung cancer – Authors' replyWe thank Chad Rusthoven and Brian Kavanagh, Farkhad Manapov and Chukwuka Eze, Glen Weiss and Zoltan Lohinai, and Xingwen Fan and colleagues for raising several important comments about our Article.1 Full-Text PDF