Study findings suggest that prophylactic cranial irradiation (PCI) yields limited benefits in patients with limited-stage small cell lung cancer (SCLC) because of the neurocognitive toxicities tied to whole-brain radiotherapy (JAMA Netw Open. 2020 Apr 1;3[4]:e201929).

“Historical data suggest that there is an overall survival [OS] benefit associated with [PCI] in patients with [SCLC]. However, as the fidelity of magnetic resonance imaging (MRI) of the brain continues to improve, this idea is now being questioned, with recent research showing no survival benefit associated with PCI in extensive-stage SCLC,” explained Todd A. Pezzi, MD, MBA, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, and colleagues, who added that the role of PCI in patients with limited-stage SCLC (LS-SCLC) remains unclear.

Therefore, Dr Pezzi et al conducted a cohort study of 297 patients with LS-SCLC to determine the OS and intracranial control rates for those who did (n = 205; median age, 62.2 years) or did not (n = 92; median age, 68.6 years) undergo PCI.

All patients received thoracic radiation and underwent at least baseline MRI, with restaging brain MRI and/or computed tomography. A propensity score-matching analysis to adjust for potential bias was calculated for 295 patients, using patient, tumor, and treatment characteristics.

The primary end points were OS and intracranial control, and data were analyzed in October 2019.

Ultimately, patients who did not receive PCI had higher 3-year cumulative incidence rates of brain metastases than recipients of PCI, when death was included as a competing risk; however, the difference was not statistically significant (20.40%; 95% CI, 12.45%-29.67% vs 11.20%; 95% CI, 5.40%-19.20%, respectively; P = .10).

There was no difference in OS between the patient groups based on PCI use (hazard ratio, 0.844; 95% CI, 0.604-1.180; P = .32).

“These findings suggest that patients with LS-SCLC staged with MRI who undergo PCI after thoracic radiation treatment were not associated with a decreased risk of developing new brain metastases compared with patients who do not undergo PCI,” Dr Pezzi and colleagues said.

“The use of PCI was not associated with an overall survival benefit for such patients,” they concluded.—Hina Porcelli