Prophylactic Cranial Irradiation in the Adjuvant Setting in NSCLC

Conference Correspondent - ASCO 2014 - Lung Cancer


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.