Is there a place for low-dose chest and prophylactic brain irradiation in limited-disease small cell lung cancer

Abstract

The aim of the study is to evaluate the outcome of low-dose bifractionated up-front radiotherapy (RT) followed by chemotherapy (CHT) in limited-disease small cell lung cancer (LD-SCLC). From December 1999 to February 2002, 20 LD-SCLC consecutive patients were treated by initial involved-field thoracic irradiation of 2 Gy twice daily to a total dose of 20 Gy, and concomitant prophylactic cranial irradiation (PCI) of 1.8 Gy twice daily to a total dose of 18 Gy followed 3 days later by 4-6 cycles of CHT with cisplatin and etoposide. Median follow-up was 66 months (52-77). There were no Grade 3-4 esophagitis or pneumonitis. Response rate was 90%, 45% of the patients showing a complete and 45% a partial response. Median time to first event was 13 months. Forty percent showed local infield recurrence, while 55% presented distant metastasis, 4 of them in the brain. Median survival time was 28 months. The Kaplan-Meier 1-, 3-, and 5-years survival rates were 95%, 35%, and 21%, respectively. Salvage RT was applied for local recurrence in 7 patients and for distant metastasis in 7 patients. The rate of brain recurrence with up-front low-dose PCI is favorable and should be further evaluated. Although the response and survival rates are promising, the high number of local recurrences indicates that the irradiation dose is insufficient for patients whose disease can be encompassed within a radical radiation portal.

Impact of Early Prophylactic Cranial Irradiation With Hippocampal Avoidance on Neurocognitive Function in Patients With Limited Disease Small Cell Lung Cancer. A Multicenter Phase 2 Trial (SAKK 15/12)

“…All patients (100%) received HA-PCI to the prescribed total dose of 25 Gy. HA-PCI was administered over a median of 13 days (range, [11][12][13][14][15][16][17][18][19][20][21]. Eight patients had a treatment delay during treatment (toxicity in 2 patients, a deterioration of general condition in 1 patient, and technical reasons in 5 patients).…”

“…11 Two other phase 2 trials found similar results with the application of PCI before the start of chemotherapy in LD SCLC. 12,13 PCI may be associated with a decline in neurocognitive function (NCF), 10,14,15 and this needs to be weighed against the reduced incidence of brain metastases.…”