Comparison of the Effectiveness of “Late” and “Early” Prophylactic Cranial Irradiation in Patients with Limited-Stage Small Cell Lung Cancer

Sas-Korczyńska, Beata; Korzeniowski, S; Wójcik, Ewa

doi:10.1007/s00066-010-2088-3

Cited by 23 publications

(23 citation statements)

References 34 publications

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“…A phase II study revealed that the incidence of brain metastasis was 7.3% in the early PCI group, when PCI was performed during chemoradiotherapy, and 20% in the late PCI group, when PCI was performed following chemoradiotherapy (P=0.00901). Consequently, the timing of PCI was hypothesized to be an important factor for decreasing the incidence of brain metastases (10). However, the increased risk of long-term neurotoxicity should be considered when PCI is used concurrently with chemotherapy (23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

“…However, the results from Auperin et al were from a subgroup analysis and should be interpreted with caution. Two prospective randomized studies comparing the optimal timing of PCI revealed conflicting conclusions; an early randomized study revealed no difference in the frequency of brain metastases between PCI performed at the start of induction treatment and PCI delivered 6 weeks later, whereas a later study demonstrated a statistically significant decrease in intracranial recurrence when PCI was performed during chemoradiotherapy as opposed to following chemoradiotherapy (9,10). Therefore, the optimal timing of PCI delivery should be established.…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer

Qiu

Xiao-fang

et al. 2016

Oncology Letters

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Abstract. The benefit of prophylactic cranial irradiation (PCI) in limited-stage small-cell lung cancer (LS-SCLC) was established in a meta-analysis performed in 1999. Since then, considerable progress has been made in the diagnosis, staging and treatment of LS-SCLC, including chemotherapy and radiotherapy, which led to a longer survival time in patients. Therefore, the magnitude of the benefit of PCI should be re-evaluated. Furthermore, the optimum timing of PCI for LS-SCLC treatment has not been established and more data is required to demonstrate this. In the present retrospective study, the cases of patients that were diagnosed with LS-SCLC between March 2005 and December 2010 were reviewed. The main eligibility criteria of patients were a diagnosis of LS-SCLC and the achievement of a complete response (CR) or near CR subsequent to receiving ≥3 cycles of cisplatin-based chemotherapy, with or without advanced thoracic radiotherapy. Early and late PCI groups were separated using the median time interval between the start of primary chemotherapy and the start of PCI. In total, 80 patients were excluded from the analysis, including 9 patients that developed brain metastases, 2 during primary chemotherapy and 7 during radiotherapy. The remaining 399 patients were deemed eligible. PCI was administered to 185 patients; 92 patients were in the early PCI group and 93 were in the late PCI group. PCI significantly decreased the incidence of brain metastases [P<0.001; HR, 0.24; 95% confidence interval (CI), 0.15-0.39] and improved the overall survival time of the patients (median survival time, 21.5-38.8 months; P<0.001; HR, 0.60; 95% CI, 0.45-0.79). However, no significant difference was identified between the early and late PCI groups, either in the incidence of brain metastases (P= 0.875) or the overall survival time (P= 0.361). Multivariate analysis revealed that PCI (P=0.004) and thoracic radiotherapy (P= 0.023) were the only 2 independent favorable prognostic factors of overall survival time. The present study demonstrates that PCI may be of considerable benefit to increase the survival rate and time of patients, and early PCI is as effective as late PCI. However, the present study recommends that PCI should be offered as soon as primary chemotherapy is completed, since there is a greater risk of developing brain metastases during thoracic radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer

Qiu

Xiao-fang

et al. 2016

Oncology Letters

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“…Because of that, the brain is considered the first site of recurrence in an aggressive tumor such as SCLC. Many randomized studies showed that in patients with LD-SCLC exhibiting CR after CRT, PCI reduces the incidence of brain metastasis and improves survival rate [2,[9][10][11][12]. Timing of PCI is a matter of debate.…”

Section: Discussionmentioning

confidence: 99%

“…Timing of PCI is a matter of debate. There was a tendency toward a decrease in the incidence of brain metastasis with early PCI [2,12]. However, early PCI is not possible in all patients for various reasons.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Silent Brain Metastasis Before Prophylactic Cranial Irradiation in Small Cell Lung Cancer

Yılmaz¹,

Kıraklı²,

Gurlek³

et al. 2017

Turk Thorac J

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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...

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“…Comparison of 30 Gy in 2-Gy daily fractions of PCI delivered after completion of chemoradiotherapy ("late" arm) and after thoracic radiotherapy but prior to the last cycle of chemotherapy ("early" arm) demonstrated that early PCI was associated with better outcome [22]. A recent intergroup phase III randomized study of 25 or 36 Gy PCI in 720 patients with limited-stage SCLC compared survival, intracranial tumor control, quality of life measures, and neurocognitive outcomes.…”

Section: Prophylactic Cranial Irradiationmentioning

confidence: 99%

Conventional radiation therapy for brain metastases

2012

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Conventional radiotherapy in the form of whole brain radiation treatment has been a longstanding treatment for brain metastases, and it continues to provide effective palliation as monotherapy and in combination with local and systemic treatments. Advances in systemic therapy have improved survival with metastatic disease, and in those patients with better prognostic factors, more aggressive local therapeutic approaches for brain metastases appear to benefit their survival and intracranial tumor control. Increased treatment intensity and longer survival following treatment of brain metastases have raised concerns about persistent treatmentrelated neurocognitive toxicities and the resulting impact on quality of life. Technological advances in conventional radiotherapy planning and delivery have led to novel approaches that may increase intracranial tumor control while minimizing the treatment-related toxicities of therapy. These innovative approaches include intensitymodulated radiotherapy, new image-guidance techniques, and volumetric modulated arc therapy, which allow for the delivery of whole brain radiotherapy with integrated boost treatment to the visible disease while sparing the hippocampal regions or delivery of hypofractionated radiotherapy to larger metastatic targets that may not be amenable to radiosurgery boost or salvage treatment.

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Comparison of the Effectiveness of “Late” and “Early” Prophylactic Cranial Irradiation in Patients with Limited-Stage Small Cell Lung Cancer

Abstract: PCI significantly decreases the incidence of brain metastases and delays their development in patients with LS SCLC. "Early" PCI is more effective than PCI applied after combined therapy.

Cited by 23 publications

References 34 publications

Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer

Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer

Frequency of Silent Brain Metastasis Before Prophylactic Cranial Irradiation in Small Cell Lung Cancer

Conventional radiation therapy for brain metastases

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