Low doses of prophylactic cranial irradiation effective in limited stage small cell carcinoma of the lung

Rubenstein, James H.; Dosoretz, Daniel E.; Katin, Michael J.; Blitzer, Peter H.; Salenius, S.; Floody, Patrick A.; Harwin, William N.; Teufel, T.; Raymond, Michael G.; Reeves, James A.; Hart, Lowell L.; McCleod, Michael; Pizarro, Alejandro; Gabarda, Antonio L.; Rana, Van G.

doi:10.1016/0360-3016(95)00166-v

Cited by 18 publications

(9 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Very recently, Rubenstein also reported an improved survival in complete responders with PCI compared with complete responders without PCI. The two-year survival in his series was 46%, identical to ours [36].…”

Section: Pcisupporting

confidence: 82%

“…Forty-six percent of complete responders with PCI are projected to be alive at two years, while the probability of being alive at the same time interval without PCI is only 18%. While the latter figure is close to the usually reported two-year survival for complete responders [16,36], a 46% two-year survival is among the highest reported [36,37]. Our finding of a significantly improved survival with PCI is in sharp contrast with published results from randomized trials [14,29,30,33,38].…”

Section: Pcisupporting

confidence: 62%

“…Finally, it is worthy of emphasis that the improvement in survival after PCI proved statistically significant only in patients with LD. Improved survival of LD patients has been very recently reported in two other studies [36,37]. This interesting observation clearly indicates that the stage of disease has to be incorporated into the inclusion criteria of trials investigating the impact of PCI on survival of patients with SCLC.…”

Section: Pcimentioning

confidence: 72%

See 2 more Smart Citations

Central Nervous System Involvement and the Role of Prophylactic Cranial Irradiation in Small Cell Lung Cancer

et al. 1997

View full text Add to dashboard Cite

This paper studies the frequency and manifestations of central nervous system (CNS) involvement and assesses the role of prophylactic cranial irradiation in small cell lung cancer (SCLC). All patients with confirmed diagnosis, admitted to our department within the last 15 years, were included. Patients were staged as having limited or extensive disease. Irradiation (40 Gy/20f) was offered to all complete responders immediately after polychemotherapy. There were 200 patients (176 men and 24 women, median age 58), 68 with limited and 132 with extensive disease. Twenty (10%) presented with CNS involvement, 14 (7%) developed it during chemotherapy and 47 (23.5%) during follow‐up. In total, 81 (40.5%) developed CNS involvement, and in 57 (28.5%) it was the main manifestation. There was no relation to disease extent or type of response to therapy. The most frequent site of metastases was brain (33%), followed by leptomeninges (6%), spinal cord (1.5%), and pituitary (1.5%). Of 79 complete responders, 51 (65%) received prophylactic cranial irradiation (PCI) and 28 (35%) did not. Frequency of CNS involvement was not significantly different (49% and 39%, respectively). Actuarial probabilities of developing CNS involvement were also not different. Nevertheless, 91% of complete responders without PCI relapsed only to CNS involvement, versus 48% with prophylactic irradiation. Cranioprophylaxis administration was followed by an improvement in overall survival, which was highly significant in limited disease. The actuarial survival of complete responders at two and four years was 46% and 26% with cranioprophylaxis versus 18% and 9% without, respectively. CNS involvement in SCLC not only is a frequent complication, but also its frequency increases with lengthening survival. The necessity of routine use of brain CT scan during staging and follow‐up is questioned in view of the present data. Administration of cranioprophylaxis did not reduce the frequency of CNS involvement in our series apparently because while it significantly delays CNS involvement, it does not abolish it. Nevertheless, survival of complete responders was prolonged with cranioprophylaxis and very significantly so in limited disease. This last finding, although clear cut, must await confirmation from randomized trials.

show abstract

Section: Pcisupporting

confidence: 82%

Section: Pcisupporting

confidence: 62%

Section: Pcimentioning

confidence: 72%

See 1 more Smart Citation

Central Nervous System Involvement and the Role of Prophylactic Cranial Irradiation in Small Cell Lung Cancer

et al. 1997

View full text Add to dashboard Cite

show abstract

“…In addition to symptomatic BM, we found that the pre-PCI BM (BM immediately before PCI) was investigated in one study (36) and the first isolated BM event, rather than overall BM during the whole disease course, was analyzed in five studies (37)(38)(39)(40)(41). Both the first isolated BM and overall BM were reported in eight papers (28)(29)(30)(42)(43)(44)(45)(46) and showed that the first isolated BM incidence was lower than the overall BM incidence (Table 1). We only performed meta-analysis for overall BM because this is more relevant than a first isolated BM event.…”

Section: Study Selection and Quality Assessmentmentioning

confidence: 99%

Risk Factors for Brain Metastases in Patients With Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

The use of prophylactic cranial irradiation (PCI) for small cell lung cancer (SCLC) patients is controversial. Risk factors for brain metastasis (BM) development are largely lacking, hampering personalized treatment strategies. This study aimed to identify the possible risk factors for BM in SCLC.We systematically searched the Pubmed database (1 January 1995 to 18 January 2021) according to the PRISMA guidelines. Eligibility criteria: studies reporting detailed BM data with an adequate sample size (randomized clinical trials [RCTs]: N ≥50; non-RCTs: N ≥100) in patients with SCLC. We summarized the reported risk factors and performed meta-analysis to estimate the pooled hazard ratios (HR) if enough qualified data (i.e., two or more studies; the same study type; the same analysis method; and HRs retrievable) were available. In total, 61/536 records were eligible (18 RCTs and 39 non-RCTs comprising 13,188 patients), in which 57 factors were reported. Ten factors qualified BM data for meta-analysis: Limited stage disease (LD) (HR = 0.34, 95% CI: 0.17–0.67; P = 0.002) and older age (≥65) (HR = 0.70, 95% CI: 0.54–0.92; P = 0.01) were associated with less BM; A higher T stage (≥T3) (HR = 1.72, 95% CI: 1.16–2.56; P = 0.007) was a significant risk factor for BM. Male sex (HR = 1.24, 95% CI: 0.99–1.54; P = 0.06) tended to be a risk factor, and better PS (0–1) (HR = 0.66, 95% CI: 0.42–1.02; P = 0.06) tended to have less BM. Smoking, thoracic radiotherapy dose were not significant (P >0.05). PCI significantly decreased BM (P <0.001), but did not improve OS in ED-SCLC (P = 0.81). A higher PCI dose did not improve OS (P = 0.11). The impact on BM was conflicting between Cox regression data (HR = 0.59, 95% CI: 0.26–1.31; P = 0.20) and competing risk regression data (HR = 0.74, 95% CI: 0.55–0.99; P = 0.04). Compared to M0–M1a, M1b was a risk factor for OS (P = 0.01) in ED-SCLC, but not for BM (P = 0.19). As regular brain imaging is rarely performed, high-quality data is lacking. Other factors such as N-stage and blood biomarkers had no qualified data to perform meta-analysis. In conclusion, younger age, higher T stage, and ED are risk factors for BM, suggesting that PCI should be especially discussed in such cases. Individual patient data (IPD) meta-analysis and well-designed RCTs are needed to better identify more risk factors and further confirm our findings. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228391, identifier CRD42021228391.

show abstract

“…This is mainly from the lack of patient stratification based on tumor stage (limited versus extensive) and response to definitive therapy. However, PCI was suggested to improve survival in patients who had a complete response (CR) to induction treatment in several retrospective studies [102,103,104]. Subsequent randomized studies of PCI have focused on patients who have achieved a CR after initial treatment.…”

Section: Prophylactic Brain Irradiation (Pci)mentioning

confidence: 99%

Treatment of Brain Metastasis from Lung Cancer

Chi

Komaki

2010

Cancers

View full text Add to dashboard Cite

Brain metastases are not only the most common intracranial neoplasm in adults but also very prevalent in patients with lung cancer. Patients have been grouped into different classes based on the presence of prognostic factors such as control of the primary tumor, functional performance status, age, and number of brain metastases. Patients with good prognosis may benefit from more aggressive treatment because of the potential for prolonged survival for some of them. In this review, we will comprehensively discuss the therapeutic options for treating brain metastases, which arise mostly from a lung cancer primary. In particular, we will focus on the patient selection for combined modality treatment of brain metastases, such as surgical resection or stereotactic radiosurgery (SRS) combined with whole brain irradiation; the use of radiosensitizers; and the neurocognitive deficits after whole brain irradiation with or without SRS. The benefit of prophylactic cranial irradiation (PCI) and its potentially associated neuro-toxicity for both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are also discussed, along with the combined treatment of intrathoracic primary disease and solitary brain metastasis. The roles of SRS to the surgical bed, fractionated stereotactic radiotherapy, WBRT with an integrated boost to the gross brain metastases, as well as combining WBRT with epidermal growth factor receptor (EGFR) inhibitors, are explored as well.

show abstract

Low doses of prophylactic cranial irradiation effective in limited stage small cell carcinoma of the lung

Cited by 18 publications

References 36 publications

Central Nervous System Involvement and the Role of Prophylactic Cranial Irradiation in Small Cell Lung Cancer

Central Nervous System Involvement and the Role of Prophylactic Cranial Irradiation in Small Cell Lung Cancer

Risk Factors for Brain Metastases in Patients With Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Treatment of Brain Metastasis from Lung Cancer

Contact Info

Product

Resources

About