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Previous Volume 341:476-484 August 12, 1999 Number 7 Next

	Full Text PDF Editorial by Carney, D. N. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Prophylactic cranial irradiation reduces the incidence of brain metastasis in patients with small-cell lung cancer. Whether this treatment, when given to patients in complete remission, improves survival is not known. We performed a meta-analysis to determine whether prophylactic cranial irradiation prolongs survival.

Methods We analyzed individual data on 987 patients with small-cell lung cancer in complete remission who took part in seven trials that compared prophylactic cranial irradiation with no prophylactic cranial irradiation. The main end point was survival.

Results The relative risk of death in the treatment group as compared with the control group was 0.84 (95 percent confidence interval, 0.73 to 0.97; P= 0.01), which corresponds to a 5.4 percent increase in the rate of survival at three years (15.3 percent in the control group vs. 20.7 percent in the treatment group). Prophylactic cranial irradiation also increased the rate of disease-free survival (relative risk of recurrence or death, 0.75; 95 percent confidence interval, 0.65 to 0.86; P<0.001) and decreased the cumulative incidence of brain metastasis (relative risk, 0.46; 95 percent confidence interval, 0.38 to 0.57; P<0.001). Larger doses of radiation led to greater decreases in the risk of brain metastasis, according to an analysis of four total doses (8 Gy, 24 to 25 Gy, 30 Gy, and 36 to 40 Gy) (P for trend=0.02), but the effect on survival did not differ significantly according to the dose. We also identified a trend (P=0.01) toward a decrease in the risk of brain metastasis with earlier administration of cranial irradiation after the initiation of induction chemotherapy.

Conclusions Prophylactic cranial irradiation improves both overall survival and disease-free survival among patients with small-cell lung cancer in complete remission.

Source Information

From the Departments of Biostatistics and Epidemiology (A.A., J.-P.P.) and Radiation Oncology (R.A., C.L.), Institut Gustave-Roussy, Villejuif, France; the Instituto de Radiomedicina, Santiago, Chile (R.A.); Western General Hospital, Edinburgh, United Kingdom (A.G.); the Medical Research Council Cancer Trials Office, Cambridge, United Kingdom (R.J.S.); the Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (P.E.G.K.); the National Naval Medical Center, Bethesda, Md. (B.E.J.); Okayama University Medical School, Okayama, Japan (H.U.); the H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa (H.W.); and the Cancer Institute of New Jersey, New Brunswick (J.A.).

Address reprint requests to Dr. Pignon at the Department of Biostatistics and Epidemiology, Institut Gustave-Roussy, 94805 Villejuif CEDEX, France, or at jppignon{at}igr.fr.

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