Prophylactic cranial irradiation beneficial in elderly SCLC patients

Sep 6 2013

By Joanna Lyford, Senior medwireNews Reporter

Prophylactic cranial irradiation (PCI) improves survival in elderly patients with limited-stage small-cell lung cancer (SCLC), analysis of US epidemiologic data indicates.

The study authors say that old age should not be considered a barrier to the use of PCI in these patients, and call for future studies to quantify the magnitude of benefit and to characterize potential adverse effects.

PCI is an established strategy to improve survival in patients with limited-stage SCLC who have had a complete response to radiotherapy and chemotherapy. However, the clinical benefit of PCI in elderly patients is unclear.

To investigate, Bree Eaton (Winship Cancer Institute of Emory University, Atlanta, Georgia, USA) used the Surveillance, Epidemiology, and End Results (SEER) database to identify 1926 patients aged 70 years and over with limited-stage SCLC.

The patients’ median age was 75 years (range 70–94 years) and 138 patients – 7.2% of the cohort – received PCI. Patients who received PCI differed from those who did not in several respects, such as being younger at the time of diagnosis, being more often diagnosed with stage III versus stage I or II disease, and being more often treated with thoracic radiotherapy.

In the primary analysis, receipt of PCI was one of many factors that were significantly associated with both overall survival (OS) and cause-specific survival (CSS). After adjusting for multiple confounders, PCI remained a significant independent predictor for OS and CSS, with adjusted hazard ratios of 0.72 and 0.66, respectively.

In the subset of patients aged 75 years and over, PCI was again significantly and independently associated with OS and CSS, with adjusted hazard ratios of 0.55 and 0.51, respectively.

In patients aged 80 years and over, however, PCI was not significantly associated with survival outcomes in either univariate or multivariate analysis.

Writing in Cancer, Eaton and co-authors say that their findings “suggest that the well-recognized benefit of PCI is still maintained in the elderly population aged > 70 years.”

They add: “Prospective studies evaluating the efficacy of PCI in older patients are required to definitively assess the magnitude of survival benefit and to characterize the neurocognitive sequelae specific to elderly patients.”

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