Wednesday, September 5, 2007

More on Prophylactic Cranial Irradiation

One of our astute residents at OSU (Hallie Prescott, MD) wrote this letter to the editor of the NEJM about the Slotman article discussed 2 weeks ago - unfortunately, we did not meet the deadline for submission, so I'm posting it here:

Slotman et al report that prophylactic cranial irradiation (PCI) increases median overall survival (a secondary endpoint) by 1.3 months in patients with small cell lung cancer. There were no significant differences in various quality of life (QOL) measures between the PCI and control groups. However, non-significant trends toward differences in QOL measures are noted in Table 2. We are not told the direction of these trends, and low compliance (46.3%) with QOL assessments at 9 months limits the statistical power of this analysis. Moreover, significant increases in side effects such as fatigue, nausea, vomiting, and leg weakness may limit the attractiveness of PCI for many patients. Therefore, the conclusion that “prophylactic cranial irradiation should be part of standard care for all patients with small-cell lung cancer” makes unwarranted assumptions about how patients with cancer value quantity and quality of life. The Evidence-Based Medicine working group has proposed that all evidence be considered in light of patients’ preferences, and we believe that this advice applies to PCI for extensive small cell lung cancer.


1. Slotman B, Faivre-Finn C, Kramer G, Rankin E, Snee M, Hatton M et al. Prophylactic Cranial Irradiation in Extensive Small-Cell Lung Cancer. N Engl J Med 2007; 357(7):664-672.
2. Weeks JC, Cook EF, O'Day SJ, Peterson LM, Wenger N, Reding D et al. Relationship Between Cancer Patients' Predictions of Prognosis and Their Treatment Preferences. JAMA 1998; 279(21):1709-1714.
3. McNeil BJ, Weichselbaum R, Pauker SG. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. N Engl J Med 1981; 305(17):982-987.
4. Voogt E, van der Heide A, Rietjens JAC, van Leeuwen AF, Visser AP, van der Rijt CCD et al. Attitudes of Patients With Incurable Cancer Toward Medical Treatment in the Last Phase of Life. J Clin Oncol 2005; 23(9):2012-2019.
5. Guyatt GH, Haynes RB, Jaeschke RZ, Cook DJ, Green L, Naylor CD et al. Users' Guides to the Medical Literature: XXV. Evidence-Based Medicine: Principles for Applying the Users' Guides to Patient Care. JAMA 2000; 284(10):1290-1296.

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