Prophylactic cranial irradiation (PCI) in extensive disease (ED) small cell lung cancer (SCLC): An audit of practice

Introduction:PCI in ED SCLC is now standard treatmentfollowing the publication of the landmark EORTC 0899322993study, demonstrating a 50% reduction in development of brainmetastases and doubling of 1 year overall survival. PCI hasformed a routine part of ED SCLC patient’s management sinceJuly 2007 at the Christie Hospital.Methods:Patients with any response to chemotherapy, PS 02and under the age of 75 were considered for PCI as per theEORTC protocol. Patients were treated in a supine positionwith two lateral opposed 6-MV photon beams and immobilisedusing a posicast mould with the neck hyper-extended. 20 Gyin 5 daily fractions was delivered. Follow up was done initiallyat six weeks post radiotherapy and then on a three monthlybasis. A prospective database recording demographics, detailsof all treatment, acute and late toxicities was created at thestart of this service. Toxicities were graded using CTC v3.0. Thedatabase was updated at each follow up visit.Results:On average 10 patients per month are seen with EDSCLC. 18 patients were referred for consideration of PCI inthe 6 month period. All patients fitted the eligibility criteria asdefined above. 14 have proceeded to PCI, with the remainderprogressing prior to PCI. No patient declined PCI. 1 patient died3 weeks after PCI, and another developed extracranial diseaseprogression four weeks after PCI. Grade 2 headache and nauseawere the commonest acute toxicities.Conclusion:Treatment acceptability was high in this poorprognostic patient group. Careful selection is needed whenconsidering PCI in ED SCLC. The treatment in itself is associatedwith little acute toxicity. It is too early too report late toxicities.