Prophylactic cranial irradiation in extensive small-cell lung cancer.
Slotman, Berend J Faivre-Finn, Corinne Kramer, Gijs Rankin, Elaine M Snee, Michael Hatton, Matthew Postmus, Pieter E Collette, Laurence Musat, Elena Senan, Suresh
Slotman, Berend J
Faivre-Finn, Corinne
Kramer, Gijs
Rankin, Elaine M
Snee, Michael
Hatton, Matthew
Postmus, Pieter E
Collette, Laurence
Musat, Elena
Senan, Suresh
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Abstract
BACKGROUND: We conducted a randomized trial of prophylactic cranial irradiation in patients with extensive small-cell lung cancer who had had a response to chemotherapy. METHODS: Patients between the ages of 18 and 75 years with extensive small-cell lung cancer were randomly assigned to undergo prophylactic cranial irradiation (irradiation group) or receive no further therapy (control group). The primary end point was the time to symptomatic brain metastases. Computed tomography or magnetic resonance imaging of the brain was performed when any predefined key symptom suggestive of brain metastases was present. RESULTS: The two groups (each with 143 patients) were well balanced regarding baseline characteristics. Patients in the irradiation group had a lower risk of symptomatic brain metastases (hazard ratio, 0.27; 95% confidence interval [CI], 0.16 to 0.44; P<0.001). The cumulative risk of brain metastases within 1 year was 14.6% in the irradiation group (95% CI, 8.3 to 20.9) and 40.4% in the control group (95% CI, 32.1 to 48.6). Irradiation was associated with an increase in median disease-free survival from 12.0 weeks to 14.7 weeks and in median overall survival from 5.4 months to 6.7 months after randomization. The 1-year survival rate was 27.1% (95% CI, 19.4 to 35.5) in the irradiation group and 13.3% (95% CI, 8.1 to 19.9) in the control group. Irradiation had side effects but did not have a clinically significant effect on global health status. CONCLUSIONS: Prophylactic cranial irradiation reduces the incidence of symptomatic brain metastases and prolongs disease-free and overall survival. (ClinicalTrials.gov number, NCT00016211 [ClinicalTrials.gov].).
Description
Date
2007-08-16
Publisher
Collections
Keywords
Brain Cancer
Lung Cancer
Lung Cancer
Type
Article
Citation
Prophylactic cranial irradiation in extensive small-cell lung cancer. 2007, 357 (7):664-72 N. Engl. J. Med.