LA-NSCLC: PCI improves DFS, reduces brain metastases risk

  • JAMA Oncol

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Prophylactic cranial irradiation (PCI) decreased the risk of brain metastases and improved disease-free survival (DFS) in patients with locally advanced (LA) NSCLC, but improved OS only in the absence of pulmonary resection.

Why this matters

  • As many as 55% of patients with LA-NSCLC develop brain metastases.

Study design

  • RTOG 0214 international, randomized phase 3 clinical trial.
  • 340 with stage IIIA/B NSCLC and then received PCI (n=163) or observation only (n=177) for brain metastases.
  • Funding: National Cancer Institute.

Key results

  • No significant difference in 5- or 10-year OS between PCI and observation (24.7% vs 26.0% and 17.6% vs 13.3%, respectively; HR, 0.82; P=.12).
  • PCI group had better 5- and 10-year DFS (19.0% vs 16.1% and 12.6% vs 7.5%, respectively; HR, 0.76; P=.03).
  • PCI group had lower rate of brain metastases (16.7% vs 28.3% at 5 and 10 years, respectively; HR, 0.43; P=.004).
  • After multivariable analysis, PCI was associated with better DFS and lower rates of brain metastases, but not OS.
  • Among patients who did not undergo pulmonary resection, PCI was associated with better OS (HR, 0.73; P=.04) and DFS (HR, 0.70; P=.01) and decreased risk of brain metastases (HR, 0.34; P=.002).

Limitations

  • Study did not reach primary endpoint of better survival.

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