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. 2017 Feb;122(2):307-312.
doi: 10.1016/j.radonc.2016.11.012. Epub 2017 Jan 7.

Prophylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer: Do all patients benefit?

Ahsan S Farooqi  1 , Emma B Holliday  1 , Pamela K Allen  1 , Xiong Wei  1 , James D Cox  1 , Ritsuko Komaki  2
Affiliations

Prophylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer: Do all patients benefit?

Ahsan S Farooqi et al. Radiother Oncol. 2017 Feb.

Abstract

Purpose: Prophylactic cranial irradiation (PCI) can improve overall survival (OS) and suppress brain metastases (BM) in patients with limited-stage small cell lung cancer (LS-SCLC) after complete response to primary therapy. However, PCI can be toxic. We sought to identify characteristics of patients who may not benefit from PCI.

Methods: We identified 658 patients who received chemoradiotherapy at MD Anderson in 1986-2012; 364 received PCI and 294 did not. Median follow-up time was 21.2months (range 1.2-240.8months). Cox proportional hazards regression, competing-risk regression, and Kaplan-Meier analyses were used to identify factors influencing OS and BM.

Results: PCI reduced risks of death [HR 0.73, 95% CI 0.61-0.88, P=0.001] and BM [HR 0.54, 95% CI 0.39-0.76, P<0.001]. Having tumors ⩾5cm increased the risk of BM [HR 1.77, 95% CI 1.22-2.55, P=0.002] but not death [HR 1.16, 95% CI 0.96-1.40, P=0.114]. Among patients ⩾70years with ⩾5-cm tumors, PCI did not improve OS [2-year rates 39.4% vs 40.9%, P=0.739].

Conclusions: PCI remains standard therapy after complete response to chemoradiotherapy for LS-SCLC. However, older patients may be at risk from comorbidity or extracranial disease. Further work is warranted to identify patients who may not benefit from PCI.

Keywords: Chemoradiation; Elderly patients; Overall survival; Prognostic factors; Prophylactic cranial irradiation; Small cell lung cancer.

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Conflict of interest statement

Conflicts of Interest: The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Brain metastasis-free survival (left) and overall survival (right) by receipt of prophylactic cranial irradiation (PCI) for patients with limited-stage small cell lung cancer treated with definitive chemoradiotherapy (p<0.001).
Fig. 2
Fig. 2
Overall survival by receipt of prophylactic cranial irradiation (PCI) for patients ≥70 years old with a primary tumor <5 cm (left) (p=0.056) or ≥5 cm (right) (p=0.739).
See this image and copyright information in PMC

References

    1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: Cancer J Clin. 2011;61:69–90. - PubMed
    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int Journal Cancer. 2010;127:2893–2917. - PubMed
    1. Hirsch FR, Matthews MJ, Aisner S, et al. Histopathologic classification of small cell lung cancer. Changing concepts and terminology. Cancer. 1988;62:973–977. - PubMed
    1. Herbst RS, Heymach JV, Lippman SM. Lung cancer. N Engl J Med. 2008;359:1367–1380. - PMC - PubMed
    1. Nugent JL, Bunn PA, Jr, Matthews MJ, et al. CNS metastases in small cell bronchogenic carcinoma: increasing frequency and changing pattern with lengthening survival. Cancer. 1979;44:1885–1893. - PubMed

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