Randomized Trial of Standard Versus Higher Dose Prophylactic Cranial Irradiation (PCI) in Limited Stage Small Cell Lung Cancer (SCLC) Complete Responders (CR): Primary End Point Analysis (PCI99-01, EORTC 22003-08004, RTOG 0212)

Carolyn Vachani, RN, MSN, AOCN
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 5, 2008

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Randomized Trial of Standard Versus Higher Dose Prophylactic Cranial Irradiation (PCI) in Limited Stage Small Cell Lung Cancer (SCLC) Complete Responders (CR): Primary End Point Analysis (PCI99-01, EORTC 22003-08004, RTOG 0212)

The use of prophylactic cranial irradiation (PCI) in patients with limited stage small cell lung cancer (SCLC) has been shown to provide an overall survival benefit (3-year overall survival of 20.7% with PCI versus 15.3% without) in a large meta-analysis (a study combining the results of several studies) by decreasing the risk of developing brain metastasis. There were a variety of doses and fractionation schemes used in the above mentioned meta-analysis.  When the total dose was examined, it appeared that there was a trend towards decreased brain metastasis with higher doses of PCI. This study looked to compare the standard PCI dose to a higher dose.

Participants (n=720) had limited stage small cell lung cancer and were randomly assigned to receive standard dose PCI (SD) or a higher dose, twice-a-day regimen (HD). Toxicities were similar in the two arms. There was no statistically significant difference in the rates of brain metastases between the groups. For unknown reasons, there were lower rates of chest recurrence in the HD group and a decrease in survival in the HD group. For now, standard dose PCI should remain the standard of care.