Prophylactic cranial irradiation in adenocarcinoma of the lung a possible role

Abstract

Seventy-eight patients with modified Stage II or Stage IIIM0 adenocarcinoma of the lung were evaluated retrospectively with regard to the impact of prophylactic cranial irradiation (PCI) (30 Gy in 15 fractions) in preventing central nervous system (CNS) metastases. Twenty patients received PCI and 58 did not. There were no significant differences between these groups with respect to age, sex, stage, or median survival (17.4 months with PCI versus 16.9 months without PCI; P = 0.6). One (5%) of 20 patients receiving PCI developed CNS metastases, compared with 14 (24%) of 58 patients not receiving PCI (P = 0.06). The time from diagnosis to development of CNS metastases and survival after CNS involvement was 51 weeks and 14 weeks, respectively, for the patient who received PCI; and a median time of 50 weeks and 26 weeks, respectively, for the patients not receiving PCI. In nine (64%) of the 14 non-PCI patients the CNS was the first and only site of relapse. A Cox regression analysis demonstrated that nodal involvement was significantly associated with an increased risk of CNS metastases. These data suggest that PCI may decrease the incidence of CNS metastases, and that it may be beneficial in the management of patients with N1 or N2 disease.

The Role of Prophylactic Cranial Irradiation for Non-small Cell Lung Cancer

“…The more recent RTOG-0214 trial (14) demonstrated a significant decrease in the risk of BM in patients with locally advanced NSCLC. Several other nonrandomised/retrospective studies demonstrated a significant benefit in a reduction of incidence of BM (11,16,19).…”

“…The largest RTC reported no significant increase in DFS for patients with NSCLC after PCI; DFS rates reported at 1 year were 56.4% and 51.2% for the PCI and observation arms, respectively (p=0.11) (14). A retrospective review by Jacobs et al also demonstrated no survival benefit with the use of PCI (19).…”

“…The literature search identified six RCTs (14-18, 21, 22) and six retrospective or non-randomised prospective trials investigating survival benefits and the incidence of BM of PCI in patients with NSCLC (7,8,11,16,19,23) (Table I). Five articles assessed the effects of PCI on NF and QOL (11,12,16,18,20) (Table II).…”

“…PCI for patients with NSCLC is not widely used due to the lack of established evidence for OS benefit and the potential for neurological toxicity post RT. PCI for NSCLC may not have an impact on OS or disease-free survival (DFS) but it has been shown to reduce the incidence of BM (11,(14)(15)(16)(17)(18)(19), therefore it is a matter of debate if these patients benefit from PCI.…”

Antidepressant use and risk of central nervous system metastasis

“…A study conducted by Vuong et al [196] found males had a higher prevalence of brain metastasis than females (p<0.001), but the frequency of brain metastasis in a study conducted by Pickren et al [131] was not different (8.8% in men and 8.7% in women). Race has not been associated with brain metastasis [131] and was not included as a covariate in the majority of studies [8,9,185,187,[189][190][191][192][193][194][195][197][198][199][200][201][202][203][204]. Breast cancer is the most common source of brain metastasis for women [5].…”