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Prophylactic Cranial Irradiation Reduces Risk of CNS Metastasis, Improves DFS in Locally Advanced NSCLC

Caroline Seymour
Published: Thursday, Mar 28, 2019

Alexander Sun, MD

Alexander Sun, MD

The use of prophylactic cranial irradiation (PCI) failed to demonstrate a statistically significant improvement in overall survival (OS) over observation in patients with locally advanced stage III non–small cell lung cancer (NSCLC); however, the modality did improve disease-free survival (DFS) and decreased the risk of brain metastasis, according to long-term follow-up of the phase III RTOG 0214 trial.

Results showed that PCI did not demonstrate a statistically significant improvement in OS over observation among patients with locally advanced stage III disease, thereby failing to meet the study’s primary endpoint (HR, 0.82; 95% CI, 0.63-1.06; P = .12). The estimated median OS was 2.4 years (95% CI, 2.0-2.9) and 2.1 years (95% CI, 1.7-2.7) among patients who underwent PCI and observation, respectively. The 5- and 10-year OS rates were 24.7% and 17.6% with PCI compared with 26.0% and 13.3% for observation, respectively.

“As the incidence of brain metastases rise in patients living longer with improved control of locoregional and distant disease, the need to establish an accepted means of prevention of brain metastases remains important,” lead study author, Alexander Sun, MD, of the Department of Radiation Oncology at the University Health Network’s Princess Margaret Cancer Centre, said in a press release.“Researchers need to identify the appropriate patient population and a safe intervention on future trials.”

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