Background: Prophylactic cranial irradiation (PCI) reduces the incidence of brain metastasis with an effect on overall survival in patients with small cell lung carcinoma (SCLC). In spite of multidisciplinary intensive treatment approaches, many patients still experience brain metastasis. The authors retrospectively analyzed the characteristics of the first failure event due to brain metastasis (FBM) in patients treated with PCI.
Methods: Between January 1990 and April 2004, 71 patients with limited disease SCLC were treated with PCI after completing systemic treatment at the National Cancer Center Hospital (Tokyo, Japan). Univariate and multivariate analyses were used to identify factors related to FBM and survival.
Results: The FBM and overall incidence of brain metastasis (OBM) were 16.9 % (12 of 71) and 26.8% (19 of 71), respectively. Median time to progressive disease and median survival were 8.4 months and 21.6 months, respectively. Elevation of pro-gastrin-releasing peptide (Pro GRP) level before PCI was found to be a significant predictive and prognostic factor for FBM, OBM, and survival on multivariate analysis (P = 0.007, P = 0.025, and P = 0.009, respectively).
Conclusions: An elevated Pro GRP level before PCI was found to be significantly related to FBM and survival, and should be considered before PCI is performed.