Omission of Prophylactic Cranial Irradiation in the Management of Limited-Stage Small-Cell Lung Cancer: Is that Ready for Prime-Time? An International Survey

Yitzhak Yehonatan, Iris M Goldstein, Olga Belochitski, David B Geffen, Ilan Shelef, Laila C Roisman, Aaron M Allen, Julia Dudnik, Nir Peled and Konstantin Lavrenkov

Department of Oncology, Soroka University Medical Center, Israel
Department of Diagnostic Radiology, Soroka University Medical Center, Israel
Davidoff Cancer Center, Rabin Medical Center, Israel
Ben Gurion University of the Negev, Israel
University of Tel Aviv, Israel

^*Correspondance to: Konstantin Lavrenkov 

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Abstract:

Background and Purpose: Prophylactic Cranial Irradiation (PCI) is considered as standard of care for patients with Limited Stage Small-Cell Lung Cancer (LS-SCLC). Several clinical studies demonstrated a narrow survival benefit for PCI. However, all of them were completed before the wide introduction of Magnetic Resonance Imaging (MRI) for diagnosis and follow up of brain metastases. Therefore, a requirement for PCI is uncertain when brain involvement can be excluded by MRI-scan. We conducted an international survey attempting to gauge the attitude of oncology professionals to possible replacement of PCI by close MRI-based surveillance in the management of LS-SCLC.
Materials and Methods: A questionnaire was designed to survey the attitudes of medical and radiation oncologists toward PCI in LS-SCLC. An invitation was sent to 638 medical and radiation oncologists by e-mail obtained from professional society directories. The e-mail contained a link to an online platform where the survey could be accessed.
Result: Responses were received from 61 oncologists employed by 47 centers, located in 15 countries. Omission of PCI in favor of MRI-based surveillance was supported by 36.1% of respondents. This support was significantly higher among medical as opposed to radiation oncologists (p=0.022). The majority of responders considered stereotactic radiosurgery as the preferred salvage therapy for brain metastases in both PCI-naive and PCI-exposed patients.
Conclusion: A substantial proportion of cancer specialists can support omission of PCI in favor of regular MRI-based follow up for patients with LS-SCLC. A randomized controlled trial is highly warranted to resolve the debate.

Keywords:

Small-cell lung cancer; Prophylactic cranial irradiation; Survey

Cite the Article:

Yehonatan Y, Goldstein IM, Belochitski O, Geffen DB, Shelef I, Roisman LC, et al. Omission of Prophylactic Cranial Irradiation in the Management of Limited-Stage Small-Cell Lung Cancer: Is that Ready for Prime-Time? An International Survey. Clin Oncol. 2021;6:1786..