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Radiother Oncol. 2019 Apr;133:163-166. doi: 10.1016/j.radonc.2018.12.014. Epub 2019 Jan 31.

Prophylactic cranial irradiation in stage IV small cell lung cancer: Selection of patients amongst European IASLC and ESTRO experts.

Author information

1
Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Switzerland. Electronic address: paul.putora@kssg.ch.
2
Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
3
Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
4
Institut Gustave Roussy, Villejuif, France; Université Paris Sud, Le Kremlin Bicetre, France.
5
Division of Cancer Sciences, University of Manchester, UK; Department of Medical Oncology, The Christie National Health Service Foundation Trust, Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence at University College London, London, UK; University of Manchester, UK.
6
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Medical Oncology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
7
Director Oncology and Hematology Department, AUSL Romagna, Ravenna, Italy.
8
Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy.
9
Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain.
10
Department of Oncology and Radiotherapy, Medical University of Gdansk, Poland.
11
Division of Molecular and Clinical Cancer Sciences, University of Manchester & the Christie NHS Foundation Trust, UK.
12
Department of Medical Oncology/Hematology, Cantonal Hospital of St. Gallen, St. Gallen, University of Bern, Switzerland.
13
Hospital Universitario Ramón y Cajal, Madrid, Spain.
14
Department of Radiation Oncology, Gustave Roussy, France.
15
Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
16
Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, University Hospital Freiburg, Germany.
17
Oncology Department, AOU San Luigi, University of Turin, Italy.
18
Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, UK.
19
Hospital Universitario, Madrid, Spain.
20
Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), the Netherlands.
21
Department of Radiation Oncology, West German Tumor Centre, University of Duisburg-Essen Medical School, Germany.
22
Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy.
23
LungenClinic Airway Research Center North (ARCN), German Center for Lung Research, Grosshansdorf, Germany.
24
Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
25
OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
26
Department Radiation Oncology, Institut Bordet, Université Libre Bruxelles, Belgium.
27
CHU de Besançon, INSERM UMR 1098, Université de Bourgogne, Franche-Comté, Besançon, France.
28
Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Austria.
29
Service de radiothérapie, CHU Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, Pierre-Bénite, France.

Abstract

BACKGROUND:

Due to conflicting results between major trials the role of prophylactic cranial irradiation (PCI) in stage IV small cell lung cancer (SCLC) is controversial.

METHODS:

We obtained a list of 13 European experts from both the European Society for Therapeutic Radiation Oncology (ESTRO) and the International Association for the Study of Lung Cancer (IASLC). The strategies in decision making for PCI in stage IV SCLC were collected. Decision trees were created representing these strategies. Analysis of consensus was performed with the objective consensus methodology.

RESULTS:

The factors associated with the recommendation for the use of PCI included the fitness of the patient, young age and good response to chemotherapy. PCI was recommended by the majority of experts for non-elderly fit patients who had at least a partial response (PR) to chemotherapy (for complete remission (CR) 85% of radiation oncologists and 69% of medical oncologists, for PR: 85% of radiation oncologists and 54% of medical oncologists). For patients with stable disease after chemotherapy, PCI was recommended by 6 out of 13 (46%) radiation oncologists and only 3 out of 13 medical oncologists (23%). For elderly fit patients with CR, a majority recommended PCI (62%) and no consensus was reached for patients with PR.

CONCLUSION:

European radiation and medical oncologists specializing in lung cancer recommend PCI in selected patients and restrict its use primarily to fit, non-elderly patients who responded to chemotherapy.

KEYWORDS:

ESTRO; Expert opinion; IASLC; PCI; Small cell lung cancer; Stage IV

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