Cranial Irradiation Prevents CNS Metastases in SCLC
|
|||||||||
|
There were no significant differences in
patient characteristics between the two arms, he said. Dr. Slotman pointed
to the patients' median time since diagnosis (4.2 months in each arm) as
"something to keep in mind when analyzing the survival curves," since
survival was measured from the time of randomization (4 to 6 weeks after
completion of four to six cycles of chemotherapy), not from the time of
diagnosis or the start of chemotherapy. At the time of analysis, 89% of
patients had been followed to progression or death.
Significantly fewer of the PCI-treated patients had brain metastases at 1 year from randomization: 14.6% vs 40.4%, for a 73% reduction in risk (P < .001). The rate of symptomatic brain metastasis as the first event was 9.1% for PCI vs 35% for controls. "In nearly all cases, when symptomatic brain metastasis was the first event, it was followed by extracranial progression," Dr. Slotman said. On the other hand, he said, extracranial disease progression was the first event in 76.2% of PCI patients vs 59.4% of controls, and was followed by brain metastases in about 10% of patients in each group. There was no significant difference in the rate of extracranial disease progression between the two arms. Of note, he said,
PCI significantly prolonged
failure-free survival and overall survival. Failure-free survival was
increased from 15.5% to 23.9% at 6 months from randomization—a 24%
reduction in risk with PCI (P = .02). Overall survival was increased from
13.3% to 27.1% at 1 year from randomization, for a 32% reduction in The treatment was well tolerated, with most adverse events being mild and manageable. The only grade 3 acute toxicity was headache in less than 5% of patients; the only grade 3 late reaction was severe headache and CNS dysfunction in three patients (2.2%). Also of importance, Dr. Slotman said, global quality of life was not compromised by PCI treatment. Fatigue, for example, "showed some difference at 6 weeks and 3 months, but then went back to normal again," he said.
|