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Lung Cancer. 2016 Nov;101:76-81. doi: 10.1016/j.lungcan.2016.09.010. Epub 2016 Sep 14.

Outcome in patients with small cell lung cancer re-irradiated for brain metastases after prior prophylactic cranial irradiation.

Author information

1
University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. Electronic address: denise.bernhardt@med.uni-heidelberg.de.
2
Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.
3
University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
4
University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany.
5
Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany; Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany.

Abstract

OBJECTIVES:

Patients with brain metastases from small-cell lung cancer (SCLC) who underwent prior prophylactic cranial irradiation (PCI) are often treated with a second course of whole brain radiation therapy (Re-WBRT) or stereotactic radiosurgery (SRS) for purposes of palliation in symptomatic patients, hope for increased life expectancy or even as an alternative to untolerated steroids. Up to date there is only limited data available regarding the effect of this treatment. This study examines outcomes in patients in a single institution who underwent cerebral re-irradiation after prior PCI.

METHODS:

We examined the medical records of 76 patients with brain metastases who had initially received PCI between 2008 and 2015 and were subsequently irradiated with a second course of cerebral radiotherapy. Patients underwent re-irradiation using either Re-WBRT (88%) or SRS (17%). The outcomes, including symptom palliation, radiation toxicity, and overall survival (OS) following re-irradiation were analyzed. Survival and correlations were calculated using log-rank, univariate, and multivariate Cox proportional hazards-ratio analyses. Treatment-related toxicity was classified according to CTCAE v4.0.

RESULTS:

Median OS of all patients was 3 months (range 0-12 months). Median OS after Re-WBRT was 3 months (range 0-12 months). Median OS after SRS was 5 months (range 0-12 months). Karnofsky performance status scale (KPS ≥50%) was significantly associated with improved OS in both univariate (HR 2772; p=0,009) and multivariate analyses (HR 2613; p=0,024) for patients receiving Re-WBRT. No unexpected toxicity was observed and the observed toxicity remained consistently low. Symptom palliation was achieved in 40% of symptomatic patients.

CONCLUSIONS:

In conclusion, cerebral re-irradiation after prior PCI is beneficial for symptom palliation and is associated with minimal side effects in patients with SCLC. Our survival data suggests that it is primarily useful in patients with adequate performance status.

KEYWORDS:

Brain metastasis; Prophylactic cranial irradiation; Re-irradiation; SCLC; Small cell lung cancer; Stereotactic radiosurgery

PMID:
27794411
DOI:
10.1016/j.lungcan.2016.09.010
[Indexed for MEDLINE]

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