Lekic M et al. / Small-cell lung cancer and brain metastases 57 with LD underwent prophylactic brain irradiation at that time. They represented only 6.8% of whole 251 patients. Twenty-six (10.4%) patients with LD were also treated with thoracic irradiation. A radical tumour dose was applied and 4-6 cycles of chemotherapy. All patients received chemotherapy, 177/251 (70.5%) with etoposide and platinum (EP), 39/251 (15.5%) with cyclophosphamide, doxorubicin, vincristine (CEV) and 35/251 (13.9) with CEV-EP (Table 3). Survival No statistical significantly difference in OS be- tween ED patients with and without brain me- tastases at the time of diagnosis was observed (p = 0.62). Median OS of 34 patients with brain me- tastases was 9 months (95% CI, 6 to 12) while me- dian OS of 153 patients with metastases in other locations at primary diagnosis was 11 months (95% CI, 10 to 12). As expected, the OS of patients with limited disease was significantly better compared to the survival of patients with either brain or other location metastases at the primary diagnosis (15 months vs 9 and 11 months, respectively, p < 0.001) (Figure 1). The number of patients with brain metastases as the only site of metastases, was too small (n = 8) to allow a separate analysis. Discussion The prognosis of patients with SCLC and brain metastases at diagnosis is poor. Nevertheless, our observations made in a substantially large popula- tion of 251 SCLC patients, who were suitable for standard specific therapy, i.e. chemotherapy and WBRT if necessary, did not confirm worse survival of ED patients with brain metastases compared to those without brain metastases at the time of diag- nosis. In our study, LD patients had significantly better median survival than ED patients (15 vs. 11 months). However, there was no significant dif- ference between the median survival of extensive stage patients with brain metastases at initial pres- entation and median survival of extensive stage pa- tients without brain metastases (9 vs. 11 months). Similar median survival (11 months) for exten- sive stage patients without brain metastases at the time of diagnosis was reported by Crane et al.15 however in this trial, with 153 patients included, survival of extensive stage patients with brain me- TABLE 3. Chemotherapeutic schemes of 251 patients EP CEV EP + CEV TOTAL Frequency 177 39 35 251 % 70.5 15.5 13.9 100.0 EP = etoposide and platinum; CEV = cyclophosphamide, doxorubicin, vincristine tastases at the time of diagnosis was only 6 months, significantly worse compared to the survival of ex- tensive stage patients without brain metastases at the time of diagnosis. The difference between our observation and that by Crane et al. might be due to the relatively small number of patients with brain metastases in both trials as well as due to possible differences in other patients’ characteristics. It is well known that the extent of the disease, charac- terized by performance status, LDH levels and the number of metastatic sites, determines the progno- sis of ED even more than the site of metastases.16-19 The percentage of patients with brain metastases in our collective of patients was rather low (13.5%) which might be the consequence of our selection criteria, i.e. performance status equal or less than 2. Performance status was found to be correlated with the extent of disease as well as CNS involve- ment.17,19 As it was clearly shown by a large pooled anal- ysis done by Hazel et al.12 and confirmed later by Giannone et al.11 through a large retrospective ob- servation with more than four hundred patients included, brain metastases alone without the ad- ditional burden of extensive disease outside the brain actually do not mean a bad prognosis at all. In these two trials the survival rates of patients with a small burden of disease, i.e. brain metastas- es alone, were actually comparable to the survival rates of patients with limited disease. The similar conclusion was done by Kochhar et al. although they retrospectively reviewed only 30 patients.20 Unfortunately, our group of patients with brain metastases as the only site of metastases, was too small to allow a separate analysis. Yet another reason for comparable survival rates of our ED patients with or without brain metastas- es might be that our entire patient received chemo- therapy in addition to WBRT. The selection of our patients was actually made according to their suit- ability for specific therapy and PS ≤ 2. Prophylactic cranial irradiation (PCI) has been explored since the 1970s as a therapeutic option Radiol Oncol 2012; 46(1): 54-59.