Experience of prophylactic cranial irradiation in extensive stage small cell lung cancer at a regional cancer center in India

Background: We conducted this randomized trial at our center to assess benefits of prophylactic cranial irradiation (PCI) in cases of extensive stage small cell lung cancer (eSCLC), who showed complete or partial response to 4 cycles of cisplatin and etoposide chemotherapy-based regime. Methods: For the study, 71 patients of histology proven SCLC with extensive stage (with no symptomatic and radiological brain metastasis) on clinico-radiological examination were randomized into two arms (Arm A and Arm B). Patients in Arm A were treated with PCI whilw those in Arm B were kept on observation, patient in both arms were followed for 1 year. Primary endpoint of the study was to assess the time of onset of symptomatic brain metastasis in both arms. Computer Tomography (CT scan) or Magnetic Resonance Imaging (MRI) was performed in patients who had any symptom suggestive of brain metastasis. Results: Patients in both arms (36 in Arm A and 35 in Arm B) were comparable for baseline characteristics. Patients in Arm A had significantly low risk of symptomatic brain metastasis then Arm B (p value = <0.005). The risk of brain metastasis in Arm A was 19.4% and in Arm B it was 51.4%. Mean duration for freedom from symptomatic brain metastasis in Arm A was 8.36 months while it was 4.49 months for Arm B. Overall 1 year median survival rate in Arm A was significantly higher in Arm A then Arm B (8 months vs 4 months). Patients in Arm A had higher toxicities, but they were mostly manageable and were not associated with poor quality of life. Conclusions: PCI is associated with significantly low risk of symptomatic brain metastasis and higher overall survival without affecting quality of life in eSCLC. Legal entity responsible for the study: Aacharya Tulsi Regional Cancer Treatment and Research Center, Bikaner. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.