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Brain metastases are common in small cell lung cancer, and guidelines for treating this disease generally recommend prophylactic cranial radiotherapy for patients who have complete remission after chemotherapy. However, most people with extensive disease are unlikely to have a complete response to chemotherapy yet are at high risk of brain metastases, with poor prognosis. Prophylactic cranial irradiation should be part of standard care for these patients too, the authors of a randomised trial have concludedconcluded.
The study group recruited 286 people with extensive disease who had shown some response to chemotherapy. Half of this group received cranial irradiation, and 24 (17%) of these 143 patients developed symptomatic brain metastases, compared with 59 (41%) of the 143 controls (hazard ratio 0.27, 95% CI 0.16 to 0.44).
The risk of extracranial progression at one year did not differ significantly between the groups, but the irradiation group survived longer without disease progression (0.76, 0.59 to 0.96) and lived for longer overall after the start of the trial (0.68, 0.52 to 0.88). Survival at one year was 27.1% (19.4% to 35.5%) in the irradiation group and 13.3% (8.1% to 19.9%) in controls.