Is prophylactic brain irradiation necessary after surgery and chemotherapy for small cell lung cancer

Objective To assess the validity of prophylactic brain irradiation for small cell lung cancer (SCLC) after operation and chemotherapy.Methods Twenty five SCLC patients after operation and chemotherapy were given prophylactic brain irradiation (R group) from March 1978 to July 1994. Male 18 and female 7. The post operative pathologic stages (Ps) were Ⅰ 8,Ⅱ 8 and Ⅲ A 9. The chemotherapy protocol: COME, COMC, CAE CE CAP. For prophylactic brain irradiation, 3 patients received 24 Gy and 22 received 30 Gy. Forty five comparable patients treated in the same period by surgery plus chemotherapy without prophylactic brain irradiation served as control (C group).Results The incidence of brain metastasis in the R group was 8% (2/25) and in the C group was 20% (9/45). The 1 ,3 ,and 5 year survival rates of the R group were 88.0%, 60% and 47.4% respectively. Those of the C group were 73.3% ,42.2%,34.2%. The 5 year survival rates of Ps Stages Ⅰ,Ⅱ,Ⅲ A of the R group were 60.0%, 57.0 %,28.6% while those in the C group were 57.0 %, 30.8% and 9.0%.Conclusions Prophylactic brain irradiation for SCLC is able to decrease the incidence of brain metastasis and prolong the survival. But this result may not be conclusive due to the limited number of patients studied.