Does Prophylactic Cranial Irradiation Extend Survival in Locally Advanced Lung Cancer?
Posted: Monday, April 15, 2019
Prophylactic cranial irradiation can decrease the number of brain metastases while increasing 5- year and 10-year disease-free survival in patients with stage III locally advanced non–small cell lung cancer (NSCLC). However, Alexander Sun, MD, of Princess Margaret Cancer Centre, Ontario, Canada, and colleagues found that it did not improve overall survival compared with observation alone. Their long-term update of the NRG Oncology/RTOG 0214 phase III trial was published in JAMA Oncology.
“As the incidence of brain metastases rises in patients living longer with improved control of locoregional and distant disease, the need to establish an accepted means of prevention of brain metastases remains important. Researchers need to identify the appropriate patient population and a safe intervention on future trials,” stated Dr. Sun in an NRG Oncology press release.
A total of 340 patients with stage IIIA or IIIB locally advanced NSCLC were randomly assigned to receive either prophylactic cranial irradiation in 2 G/fraction over 5 days a week up to 30Gy or observation. All patients were evaluated at 5 and 10 years, with an overall median follow-up of 2.1 years. Those still living had a median follow up of 9.2 years.
Overall survival with prophylactic cranial irradiation and observation did not significantly differ at the 5-year or 10-year mark (hazard ratio = 0.82). However, disease-free survival improved with prophylactic cranial irradiation, increasing from 12.6% with observation to 19% with treatment at 5 years and 7.5% to 16.1% at 10 years. Additionally, brain metastases were 57% less common after prophylactic cranial irradiation. Patients younger than age 60 and those with nonsquamous disease developed more brain metastases.
For a subgroup of patients (n = 225) who did not undergo surgery during their primary treatment, there were statistically significant differences in overall survival, disease-free survival, and brain metastases with prophylactic cranial irradiation. For this subgroup, prophylactic cranial irradiation prolonged overall survival and decreased brain metastases.
Disclosure: The study authors’ disclosure information may be found at jamanetwork.com.