PCI in NSCLC

[Palex80]

1. Do any of you offer it to patients?

2. What do you think future developments in this field will be, now that RTOG 0214 was terminated early, thus limiting the evidence we were hoping for?

Cheers!

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[Brim]

1. No

 

[fettucine]

There's evidence of some benefit from German RCT I believe November 2007 JCO, but I think it was for Stage IIIA, and neurocognitive assessments were not different. I think there have been 5 other RCT, largest and oldest one was from Cox JAMA 1981, and russell 1991, which showed lower brain relapses with PCI.

This idea is not a new one. Topkan also had a recent review and future directions of PCI in NSCLC, I think Feb 2009 in Oncology. I think it is worthwhile to consult patient with locally advanced Lung cancer regarding the available data, but I do not think anybody would do it routinely. NSCLC patients do not get PCI at our instiution (Maybe they should, our IIIB's have piss-poor survival rates).

-f8

 

[Palex80]

Thank you very much for your input.

I must say, that I find it quite interesting to see how once again radiation oncologists are scared of side-effects and have for decades missed the opportunity to establish PCI for locally advanced NSCLC.

This phenomenon appears to me even more striking, when one considers that many of us routinely offer PCI for ED-SCLC. PCI for ED-SCLC is a prophylactic therapy on the one hand but in a palliative setting on the other hand.

So, we would rather expose our patients with ED-SCLC, who we cannot cure anyway to a further treatment, knowing that we will only prolong the survival for a matter of weeks (6 weeks in the Slotman trial).
Surely it's easy to offer it, because you don't have to worry about late sequlae in ED-SCLC.

But isn't it quite ironic to see that we are rather treating those who we cannot cure more aggressively (ED-SCLC), than those which we may have been able to cure (LA-NSCLC) with PCI?


On a side note:
Two weeks ago we discussed the case of a patient with a G3, adenocarcinoma who was underwent resection for a Stage IIIA NSCLC ypT3 ypN2 (8/24) cM0 R0 after neoadjuvant chemo. He was referred for adjuvant mediastinal radiation therapy to out institution.
While discussing his case, several of my colleagues stressed out, that it would probably be wiser to irradiate the brain rather than the mediastinum, if we wanted to enhance this patient's chances of surviving his cancer.