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Quality of life suffers with cranial radiation to prevent lung cancer metastases

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – While prophylactic cranial irradiation can reduce the occurrence of brain metastases and improve survival in patients treated for extensive-disease small-cell lung cancer, it may adversely affect quality of life, new research shows.

Based on these findings, Dr. Berend J. Slotman, from VU University Medical Center, Amsterdam, the Netherlands, and colleagues conclude that “patients should be told of the benefits of PCI and of its possible negative impact on quality of life, empowering them with relevant information to allow informed, individualized treatment choices.”

As reported in the December 1st issue of the Journal of Clinical Oncology, the investigators assessed survival, quality of life, and other outcomes in 286 patients with extensive-disease small-cell lung cancer who had responded to chemotherapy and were randomly assigned to either observation or prophylactic irradiation.

Health-related quality of life (HRQOL) was assessed with the European Organization for the Research and Treatment of Cancer core HRQOL tool and brain module at baseline, 6 weeks, 3 months, and then every 3 months for up to 1 year and every 6 months beyond that point.

While 94.7% of subjects completed the HRQOL assessments at baseline, by 6 weeks compliance had dropped to 60%.

Consistent with prior research, brain metastases were less common in radiation-treated patients and survival was enhanced. Their HRQOL, however, suffered for it. In particular, fatigue and hair loss were more significant problems for these patients than for controls.

Overall, 34.7% of patients undergoing cranial radiation had a drop of 20 points or more in their global health score at 3 months, compared to 22.2% of controls.

Clinicians should be alert to the potential adverse effects of cranial irradiation, “monitor their patients; and offer appropriate support, clinical, and psychosocial care,” the authors state.

J Clin Oncol 2008;26.