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Prophylactic Cranial Irradiation for Locally Advanced NSCLC

Non-small cell lung cancer.

Patients with locally advanced non-small cell lung cancer (NSCLC) are at high risk for developing brain metastases. In other cancers that have a propensity to metastasize to the brain, including small cell lung cancer, a treatment called prophylactic cranial irradiation (PCI) is used in order to prevent brain metastases. Now, a phase 3 clinical trial reports that PCI also decreases a patient's chances of developing brain metastasis in NSCLC.

In this study, which was published in JAMA Oncology, 340 patients with stage III NSCLC were randomized to receive either PCI or observation. The results showed that PCI did not significantly increase overall survival compared with observation. However, the five-year disease-free survival rate was significantly higher in patients receiving PCI compared with those receiving only observation (19.0% vs 12.6%). In addition, patients receiving PCI were 57% less likely to develop brain metastases compared with those receiving only observation.

"As the incidence of brain metastases rises in patients living longer with improved control of loco-regional 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 Alexander Sun, MD, Assistant Professor in the Department of Radiation Oncology at the University of Toronto and lead author of the study.

Even though improved overall survival was not reached with PCI, the treatment will still benefit many patients with locally advanced NSCLC by reducing the incidence of brain metastases and increasing the rate of disease-free survival.

For More Information

Sun A, Hu C, Wong SJ, et al (2019). Prophylactic cranial irradiation vs observation in patients with locally advanced non-small lung cancer. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2018.7220

Clinicaltrials.gov (2018). Radiation therapy in preventing central nervous system (CNS) metastases in patients with non-small cell lung cancer. NLM identifier: NCT0048997. 

Image Courtesy of Roche Diagnostics

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