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Clin Lung Cancer. 2017 Jul;18(4):e267-e271. doi: 10.1016/j.cllc.2016.11.012. Epub 2016 Dec 2.

Nine-year Experience: Prophylactic Cranial Irradiation in Extensive Disease Small-cell Lung Cancer.

Author information

1
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany. Electronic address: denise.bernhardt@med.uni-heidelberg.de.
2
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
3
Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg Translational Lung Research Centre, Heidelberg, Germany; German Centre for Lung Research, Heidelberg, Germany.
4
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
5
Department of Radiation Medicine, Georgetown University Hospital, Washington, DC.
6
Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany.
7
German Centre for Lung Research, Heidelberg, Germany; Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany.
8
German Centre for Lung Research, Heidelberg, Germany; Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.

Abstract

BACKGROUND:

In 2007, the European Organization for Research and Treatment of Cancer (EORTC) study (ClinicalTrials.gov identifier, NCT00016211) demonstrated a beneficial effect on overall survival (OS) with the use of prophylactic cranial irradiation (PCI) for extensive disease (ED) small-cell lung cancer (SCLC). Nevertheless, debate is ongoing regarding the role of PCI, because the patients in that trial did not undergo magnetic resonance imaging (MRI) of the brain before treatment. Also, a recent Japanese randomized trial showed a detrimental effect of PCI on OS in patients with negative pretreatment brain MRI findings.

MATERIALS AND METHODS:

We examined the medical records of 136 patients with ED SCLC who had initially responded to chemotherapy and undergone PCI from 2007 to 2015. The outcomes, radiation toxicity, neurologic progression-free survival, and OS after PCI were analyzed. Survival and correlations were calculated using log-rank and univariate Cox proportional hazard ratio analyses.

RESULTS:

The median OS and the median neurologic progression-free survival after PCI was 12 and 19 months, respectively. No significant survival difference was seen for patients who had undergone MRI before PCI compared with patients who had undergone contrast-enhanced computed tomography (P = .20). Univariate analysis for OS did not show a statistically significant effect for known cofactors.

CONCLUSION:

In the present cohort, PCI was associated with improved survival compared with the PCI arm of the EORTC trial, with a nearly doubled median OS period. Also, the median OS was prolonged by 2 months compared with the irradiation arm of the Japanese trial.

KEYWORDS:

Brain metastasis; ED; PCI; SCLC; Survival

PMID:
28027850
DOI:
10.1016/j.cllc.2016.11.012
[Indexed for MEDLINE]

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