Evaluating the outcomes of prophylactic cranial irradiation for the treatment of non-small cell lung cancer with a high-risk of developing brain metastases

This study investigated the effectiveness and outcomes of using prophylactic cranial irradiation (PCI) in patients with non-small cell lung cancer (NSCLC) with a high risk for developing brain metastases (BM). The data showed that PCI significantly decreased the risk of developing BM and increased the overall survival in these patients.

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Treatment for NSCLC includes chemotherapy, radiotherapy, and surgical removal of tumors. In 20-40% of cases, NSCLC spreads from the lung to the brain. There are very few effective treatments available for NSCLC brain metastases (BM).

Prophylactic cranial irradiation (PCI) involves radiation therapy to the brain. It is used to prevent BM in patients with small-cell lung cancer. However, studies evaluating the usefulness of PCI in patients with a high risk for developing BM are not known.

This study involved 84 patients with NSCLC. The patients were randomly assigned to 2 groups. Group 1 included 41 patients who received standard of care (SoC) plus PCI (25 Gy in 10 sessions). Group 2 included 43 patients who only received SoC. The average follow-up time was 29.1 months.

4% of patients in group 1 developed BM after 12 months compared with 24% in group 2. After 2 years, 7% of patients in group 1 developed BM compared with 38% in group 2. Patients who received PCI plus SoC were 88% more likely to not develop BM compared to those who only received SoC.

The average overall survival was 64.5 months for patients who received PCI compared with 19.8 months for patients who only received SoC. PCI was associated with a 59% higher chance of a longer survival compared to SoC alone.

This study concluded that adding PCI to SoC significantly decreased the risk of developing BM and increased the survival rates of patients with NSCLC with a high risk of BM.

This study had a small number of participants. This study was designed and conducted before the widespread use of immunotherapy. Also, there was no data on the side effects associated with PCI.