161 Acute toxicity of prophylactic cranial irradiation (PCI) in extensive stage small cell lung cancer (ES-SCLC): A prospective audit from a UK radiotherapy centre

Introduction: PCI is standard of care for good performance status (PS) ES-SCLC [1] and is recommended in national and local guidelines. However concerns regarding the toxicity of PCI prompted an audit at the Christie to assess acute toxicity and adherence to local guidelines. Method: A prospective audit of patients with ES-SCLC eligible for PCI was carried out between February 2010 and July 2011. Patients were eligible as per local guidelines if age ≤75, WHO PS 0-2, chemotherapy response and no clinical evidence of brain metastasis were present. Age, PS, respiratory score, steroid use and early toxicity (CTCAE v3.0) were recorded at baseline, 5 days, 6 weeks and 12 weeks. Doses of radiotherapy for PCI and thoracic radiotherapy (tRT) were noted. Results: 31 patients, median age 67 (33-74) were included. Baseline PS was 0, 1 or 2 in 2 (6.3%), 20 (62.5%) and 9 (28.1%) patients respectively. PCI dose was 20 Gy/5# in all patients. Prophylactic dexamethasone was given in 28/31 (2 8 mg daily). Nine (29%) patients also received tRT, 20 Gy/5# (n = 2) or 30 Gy/10# (n = 7). Two patients (6.5%) had complete response to chemotherapy, 29 (93.5%) had a partial response. For toxicity please see table 1. Nine patients died prior to 12 week review, seven of whom developed progressive disease. (Table presented) Conclusions: The main limitation of this audit is that nine patients died prior to twelve week review. The data shows that we adhere to local guidelines and that the main toxicity after PCI is fatigue. Most patients experience grade 0 or 1 for other toxicities. PCI is generally well tolerated in the acute setting but fatigue is a problem. To preserve the benefit seen with PCI, patient selection remains important.