OBJECTIVES:Prophylactic cranial irradiation (PCI) decreases incidence of brain metastasis and improves survival in patients with limited disease-small cell lung cancer (LD-SCLC) who achieved complete response (CR) after treatment. There is no satisfactory evidence about the necessity of new brain imaging for asymptomatic metastasis immediately prior to PCI. The present study aimed to evaluate the frequency of brain metastasis in SCLC patients without neurological symptoms who are candidates for PCI. MATERIAL AND METHODS:The data files of 243 patients with SCLC referred for cranial irradiation were retrospectively reviewed. The patients with following characteristics were enrolled to the study; 1) LD-SCLC patients with CR after chemoradiotherapy who are candidates for PCI. 2) No neurological signs or symptoms of brain metastasis after chemoradiotherapy. 3) Having brain imaging at initial diagnosis and before PCI. RESULTS:Ninety-nine patients (83 male, 83.3%) were included in this study. Median age was 60 years. Time interval between initial and reevaluation for brain metastasis was median 5.5 months (range; 4.7-7.1). Asymptomatic brain metastasis rate was 20.2% (18/99). CONCLUSION:Even if local disease is under control, asymptomatic brain metastasis is not rare. Therefore, patients who are candidates for PCI after completion of chemoradiotherapy should be reimaged for brain metastasis before PCI. KEYWORDS: Prophylaxis, brain, imaging, SCLC, metastasis INTRODUCTIONApproximately 30% of patients with small cell lung cancer (SCLC) initially staged as limited disease (LD) are candidates for combined model treatment (CMT) with curative intent. CMT with sequential or concurrent chemoradiotherapy (CRT) achieves complete response (CR) in 50%-60% of patients. However, the blood-brain barrier precludes the penetration of chemotherapeutic agents to the brain. The risk for brain metastasis occurrence is approximately 50% in the first 2 years after diagnosis [1]. Silent brain metastasis may develop at some point during the treatment course even in patients with a CR of intrathoracic disease. Emerging evidence suggests that prophylactic cranial irradiation (PCI) in patients with LD-SCLC who have achieved CR after CRT reduces the incidence of brain metastasis and improves survival [2,3]. However, the recommended dose for whole brain radiotherapy in patients with brain metastasis differs from the preferred dose for PCI [2].Lung cancer guidelines recommend routine initial evaluations for brain metastasis with contrast-enhanced (CE) magnetic resonance imaging (MRI) or computed tomography (CT) in patients with SCLC [4,5]. The necessity of radiological reevaluation to detect asymptomatic brain metastasis before PCI has not been remarked on the guidelines, contrary to recommendations for the initial staging of SCLC.Manapov et al. [6] detected silent brain metastasis in 32.5% of small patients size with LD-SCLC who were complete responders to CRT with pre-PCI second CE-MRI. However, there is a paucity of data on the frequency of asympt...
No correlation was observed between bcl-2 expression and local control or overall survival. Whereas hemoglobin level, age and existence of a recurrence had a prognostic impact on overall survival, patient age and smoking status influenced local control rates.
Objective: Concomitant chemoradiotherapy (CRT) is the standard treatment for patients with stage III non-small cell lung cancer (NSCLC). Myelosuppression can be a significant problem in concomitant CRT. The aim of this study was to assess the parameters obtained before concomitant CRT to define the risk factors for myelosuppression in patients with locally advanced NSCLC. /w, on weeks 1-8) concurrently with thoracic radiotherapy to a total dose of 40-66.6 Gy. The risk factors were examined for their association with myelosupression (grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, or anemia) by logistic regression analysis. Results:Grade 3 or higher neutropenia, leukopenia, thrombocytopenia, or anemia occurred in 51.8%, 53%, 8.6%, and 7.4% of the patients, respectively. Multivariate analysis revealed that the risk factors for neutropenia were performance status (p=0.032), white blood cell count (p=0.023), and pretreatment creatinine level (p=0.018). On multivariate analysis, white blood cell count (OR, 3.311; p=0.027; 95% CI, 1.148-9.545) was found as significant risk factor for CRT-induced leukopenia Conclusion: Patients with a poor pretreatment performance status, low white blood cell count, and high creatinine level are at a risk of myelosupression. These characteristics of the patients should be considered while making treatment decisions.
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