ASCO: Brain Irradiation Fends Off Metastases in Small Cell Lung Cancer

CHICAGO, June 2 -- Prophylactic cranial irradiation after chemotherapy significantly reduces the risk of brain metastasis and doubles one-year survival in small-cell lung cancer (SCLC), a Dutch oncologist reported here.

SCLC patients who exhibited any response to chemotherapy and then received prophylactic whole-brain irradiation had a 14.6% rate of symptomatic brain metastases at one year compared with 40.4% for those not getting radiation (P

"Prophylactic cranial irradiation significantly reduces the risk of symptomatic brain metastases and significantly prolongs survival," said Dr. Slotman. "This prophylactic irradiation is well tolerated and does not adversely influence quality of life. Prophylactic cranial irradiation should now routinely be offered to all responding SCLC patients with extensive disease."

Dr. Slotman said in an interview that the radiation fends off symptomatic brain metastases by destroying micrometastases that have already taken up residence in the brain. The lesions are too small to detect by brain imaging but provide the genesis for malignant growth. Unfortunately, the benefits of prophylactic whole-brain irradiation do not extend beyond SCLC to the much more common non-small cell lung cancer, he added.

A U.S. oncologist familiar with the study but not involved in it agreed that prophylactic brain irradiation should become the standard of care. He also predicted that U.S. physicians will not be hesitant to adopt the therapy.

"I expect prophylactic cranial irradiation will be taken up quickly in the U.S., as well," commented Roy Herbst, M.D., of the University of Texas M. D. Anderson Cancer Center in Houston. "I think this will take standards of care to a new level."