Laurie E. Gaspar, MD, FRCP(C)

During investigation of an episode of self-limiting abdominal pain, a 63-year-old Caucasian female never-smoker was found to have an asymptomatic right lower lobe pulmonary mass. A positron-emission tomography/computed tomography (PET/CT) scan revealed the right lower lobe mass to be 25 × 32 mm with a standardized uptake value (SUV) of 10.2, without evidence of hilar or mediastinal lymphadenopathy or of distant metastases.

It is well known that the prognosisfor patients with brain metastasesfrom small cell lung cancer(SCLC) is very poor, with mediansurvivals in the range of 3 to 14months.[1-3] As pointed out by Quanet al, brain metastasis is an importantissue, given that approximately 60%of SCLC patients will develop brainmetastases sometime in the course oftheir disease. Quan et al set out towrite an article on the treatment ofbrain metastases from SCLC, but theyoften have to refer to the results ofstudies of brain metastases from othersites. Unfortunately, many studiesspecifically exclude SCLC-relatedbrain metastases, and therefore,advances in their treatment havebeen few.

This review by Dr. Gore emphasizesthe significance of theproblem of brain metastases inpatients with locally advanced non–small-cell lung cancer (NSCLC). Thearticle should prompt medical and radiationoncologists to consider enrollingpatients in the ambitious study ofprophylactic cranial irradiation (PCI)led by the Radiation Therapy OncologyGroup (RTOG L-0214). Statisticsfrom the ongoing RTOG study arecomplicated, but essentially, the researchersare looking for a 20% increasein median survival for patientsreceiving PCI. This would make theimpact of PCI in NSCLC comparableto that observed in limited small-celllung cancer (SCLC).