Successful treatment of brain metastasis developing after prophylactic cranial irradiation in patients with small-cell lung cancer by low-dose whole brain irradiation plus intra-arterial infusion of cisplatin

Problem: Overall survival has been substantially improved in limited disease small-cell lung cancer (LD-SCLC) with a combination of thoracic irradiation and systemic chemotherapy. However, late brain relapse, developing especially after prophylactic cranial irradiation (PCI), is one of the major obstacles to achieving the further improvement. Methods: Sixty-nine patients with LD-SCLC who developed brain relapse were retrospectively analyzed to evaluate the effect of salvage treatment on survival. Of those, 55 patients have received PCI. Results: A combined modality treatment consisting of low-dose cranial irradiation plus intra-arterial infusion of cisplatin resulted in better long-term survival for SCLC patients with brain relapse after PCI compared with cranial irradiation alone or best supportive care alone. A 42-year old patient receiving the CMT has continued a complete response for 10 years. Conclusions: A combined modality treatment consisting of low-dose cranial irradiation plus intra-arterial infusion of cisplatin is effective for treatment of brain relapse and warrants further study in SCLC patients developing brain metastasis after PCI.