The invisible enemy.

Prophylactic cranial irradiation (PCI) is not commonly used for non-small cell lung cancer (NSCLC). Even though it reduces the risk of developing brain mets, it hasn’t had a major impact on survival outcomes...at least not in a consistent explainable way. This individual patient data meta-analysis of four randomized trials including 924 patients found a statistically significant improvement in progression-free survival (4.7% absolute difference at 5 years) and brain metastasis-free survival (4.2% difference at 5 years). However, there was still no difference in overall survival. Coupled with advances in immunotherapy and shift towards focal treatment of brain mets, we’re still unlikely to see a change in PCI practice patterns for NSCLC. | Witlox, Radiother Oncol 2021

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