Prophylactic Cranial Irradiation in the Adjuvant Setting in NSCLC
The value of prophylactic cranial irradiation (PCI) in decreasing the incidence of brain metastases in patients with NSCLC has been demonstrated, but a new study presented at ASCO 2014 examined the impact of PCI on survival (Wang S-Y, et al. ASCO 2014. Abstract 7508). In an open-label, randomized trial, 156 patients with fully resected Stage IIIA N2 NSCLC and a high risk of cerebral metastases, who had no disease recurrence after adjuvant chemotherapy, were randomized to receive PCI (30 Gy in 10 fractions) or observation (Obs). Mean disease-free survival (DFS) was significantly longer in the PCI group compared with Obs (28.5 vs 21.2 months; P = .037). The 3- and 5-year DFS rates were also increased with PCI compared with Obs, and the 5-year brain relapse rate was significantly lower in the PCI group versus Obs (13.6% vs 41.3%; P <.001). The 3- and 5-year overall survival (OS) rates with PCI versus Obs were 44.5% versus 27.4% and 38.7% versus 22.8%, respectively. This study conclusively showed the value of PCI in increasing DFS, OS, and decreasing the incidence of brain metastases in NSCLC in the adjuvant setting.