TY - JOUR
T1 - Non-small cell lung cancer and central nervous system metastases
T2 - Should we be using prophylactic cranial irradiation?
AU - Gore, Elizabeth
AU - Choy, Hak
N1 - Funding Information:
RTOG has an on going phase III study evaluating PCI for patients with LA-NSCLC. This study is endorsed by Eastern Cooperative Oncology Group (ECOG), SWOG, National Cancer Institute of Canada Clinical Trials Group (NCIC CTG), North Central Cancer Treatment Group (NCCTG), and Cancer and Leukemia Group B (CALGB) and is available for enrollment through Clinical Trials Support Unit (CTSU). Patients who have completed definitive locoregional therapy (surgery and/or radiation therapy with or without chemotherapy) for LA-NSCLC and have no evidence of progressive disease or distant metastases are eligible. Patients are randomized to PCI (2 Gy per fraction to 30 Gy) or close observation. Patients are stratified by histology (squamous versus nonsquamous), therapy (surgery versus no surgery), and stage (IIIA versus IIIB). This study is powered to show a survival advantage. Both groups undergo neuropsychological and quality of life testing at regular intervals.
PY - 2004/10
Y1 - 2004/10
N2 - Central nervous system (CNS) failure in patients with locally advanced non-small cell; lung cancer (LA-NSCLC) is a common and debilitating problem. Standard follow-up after local regional therapy does not include routine radiologic evaluation of the brain. Imaging is performed at the onset of symptoms followed by palliative therapy for CNS failure. Some investigators support regular screening with therapy for failures before the onset of symptoms. This alternative may decrease the impact of CNS failures and lengthen survival. Other investigators have shown that prophylactic cranial irradiation (PCI) for LA-NSCLC decreases the incidence of CNS failures. The potential survival, quality of life, and neuropsychological advantage or disadvantage of these two approaches has not been systematically studied. This article will review the problem of CNS failures in patients with LA-NSCLC and the potential risks and benefits of close observation and PCI. The necessity of conducting an ambitious study evaluating the potential survival advantage of PCI will be discussed.
AB - Central nervous system (CNS) failure in patients with locally advanced non-small cell; lung cancer (LA-NSCLC) is a common and debilitating problem. Standard follow-up after local regional therapy does not include routine radiologic evaluation of the brain. Imaging is performed at the onset of symptoms followed by palliative therapy for CNS failure. Some investigators support regular screening with therapy for failures before the onset of symptoms. This alternative may decrease the impact of CNS failures and lengthen survival. Other investigators have shown that prophylactic cranial irradiation (PCI) for LA-NSCLC decreases the incidence of CNS failures. The potential survival, quality of life, and neuropsychological advantage or disadvantage of these two approaches has not been systematically studied. This article will review the problem of CNS failures in patients with LA-NSCLC and the potential risks and benefits of close observation and PCI. The necessity of conducting an ambitious study evaluating the potential survival advantage of PCI will be discussed.
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U2 - 10.1016/j.semradonc.2004.06.001
DO - 10.1016/j.semradonc.2004.06.001
M3 - Article
C2 - 15558503
AN - SCOPUS:8844283481
SN - 1053-4296
VL - 14
SP - 292
EP - 297
JO - Seminars in Radiation Oncology
JF - Seminars in Radiation Oncology
IS - 4
ER -