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Oncology Learning NetworkProphylactic Cranial Irradiation Improved Survival Outcomes Compared to Consolidative Thoracic Radiation Therapy in Extensive-Stage Small Cell Lung Cancer

New Study Reveals PCI Offers Better Overall and Progression-Free Survival Rates Compared to TRT

In a recent comparison study, researchers have found that prophylactic cranial irradiation (PCI) offers significant advantages over consolidative thoracic radiation therapy (TRT) in treating patients with extensive-stage small cell lung cancer (SCLC) who have previously undergone chemotherapy, with or without immunotherapy. The findings could have major implications for treatment protocols in this aggressive form of lung cancer.

HCN Medical Memo
This study provides compelling evidence that PCI may offer better outcomes in both overall and progression-free survival compared to TRT. Given the aggressive nature of this cancer and the ongoing debate over the efficacy of TRT and PCI, these findings could be a game-changer in treatment protocols. Further trials are needed, but for now, PCI appears to be the more effective option.

Key Points
  • Researchers divided 163 patients with extensive-stage SCLC into cohorts based on systemic therapy use and further categorized them by PCI or TRT treatment.
  • Median overall survival (OS) for patients undergoing PCI was 15 months, compared to 10 months for those receiving TRT (P = 0.02).
  • Median progression-free survival (PFS) was 8.5 months in the PCI group, versus 5 months in the TRT group (P = 0.02).

“Extensive-stage [SCLC] continues to have poor survival due to its aggressive behavior, despite improvements with incorporation of immunotherapy with standard chemotherapy. Controversy exists regarding the role of TRT and PCI in [extensive-stage]-SCLC due to high recurrence rates.”
– Andrew J. Gross, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Ohio, and coauthors

Additional Points
  • The study used the Kaplan-Meier method to estimate OS and PFS, and multivariable (MVA) Cox regression to estimate treatment effects.
  • Researchers noted that a future trial is needed to evaluate the role of TRT and PCI in the era of chemo-immunotherapy.

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