Sep 10, 2012 | Posted by: roboblogger
Stage III non-small cell lung cancer patients treated with surgery and/or radiation therapy have a significantly reduced risk of developing brain metastases if they also receive prophylactic cranial irradiation ; however, this study did not show an improvement in overall survival with PCI, according to research presented at the 2012 Chicago ... (more)
Since: Dec 05
Prophylactic Cranial Irradiation Fails to Improve NSCLC Survival
PCI did not improve overall survival in a randomized trial of 340 patients in this study. Movsas, et al study of PCI vs Observation in Patients with Stage III NSCLC (ASTRO 2009) found that there was no significant impact on quality of life, patients who underwent PCI had a greater decline in immediate memory recall and delayed memory recall than patients who did not have PCI.
According to Movsas, these findings offer a more complete perspective regarding this intervention for patients with NSCLC. So in regards to NSCLC, there is no proven value of PCI for NSCLC. Whether NSCLC or SCLC, if they prophylactically irradiated just the whole brain but not the spinal cord, how does it benefit the patient? Any "theoretical" cancer cells in the spinal cord would eventually infiltrate the brain.
And it is likely that the true incidence of treatment-related side effects of cranial irradiation in adults who survive more than six months without brain tumor growth or recurrence has been significantly underestimated.
The question of whether systemic therapies can be as effective as PCI with a more favorable side effect profile is an interesting one, and one that might have more value with agents like tyrosine kinase inhibitors like Iressa and Tarceva against brain metastases. The poor survival of leptomeningeal metastases by PCI highlights the importance of treating lung cancer patients with TKIs on outcomes.
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