Prophylactic Cranial Irradiation for Resectable Small-Cell Lung Cancer

Halthore, Aditya; Goenka, Anuj; Sharma, Rajiv; Knisely, Jonathan

doi:10.1016/j.cllc.2017.08.004

Cited by 11 publications

(6 citation statements)

References 23 publications

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“…The BMs from SCLC had the worst prognosis among all the BMs of lung cancer. PCI is identified as one of the major treatments for SCLC [ 6 ]; however, its preventive effect is not optimal due to high recurrence rate and neurotoxicity [ 5 , 23 – 25 ]. Several clinical studies have believed that hippocampus-sparing radiation avoids the neurotoxic side effects to some extent [ 8 , 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Exploration of spatial distribution of brain metastasis from small cell lung cancer and identification of metastatic risk level of brain regions: a multicenter, retrospective study

et al. 2021

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Objectives This study aimed to explore the spatial distribution of brain metastases (BMs) from small cell lung cancer (SCLC) a homogenous sample, and to identify the metastatic risk levels in brain regions. Methods T1-enhanced magnetic resonance imaging (MRI) from SCLC patients were retrospectively reviewed from three medical institutions in China. All images were registered to the standard brain template provided by the Montreal Neurological Institute (MNI) 152 database, followed by transformation of the location of all BMs to the space of standard brain. The MNI structural atlas and Anatomical Automatic Labeling (AAL) atlas were then used to identify the anatomical brain regions, and the observed and expected rates of BMs were compared using 2-tailed proportional hypothesis testing. The locations and sizes of brain lesions were analyzed after image standardization. Results A total of 215 eligible patients with 1033 lesions were screened by MRI, including 157 (73%) males and 58 (27%) females. The incidence of crucial structures were as follows: hippocampus 0.68%, parahippocampal 0.97%, brainstem 2.05%, cauate 0.68%, putamen 0.68%, pallidum 0.2%, thalamus 1.36%. No BMs were found in the amygdala, pituitary gland, or pineal gland. The cumulative frequency of the important structures was 6.62%. Based on the results of MNI structural atlas, the cerebellum, deep white matter and brainstem was identified as a higher risk region than expected for BMs (P = 9.80 ×10−15, 9.04 ×10−6), whereas temporal lobe were low-risk regions (P = 1.65 ×10−4). More detailed AAL atlas revealed that the low-risk regions for BMs was inferior frontal gyrus (P = 6.971 ×10−4), while the high-risk regions for BMs was cerebellar hemispheres (P = 1.177 ×10−9). Conclusion Many crucial structures including the hippocampus, parahippocampus, pituitary gland and thalamus etc. have low frequency of brain metastases in a population of SCLC patients. This study provides the help to investigate the clinical feasibility of HA-WBRT and non-uniform dose of PCI in a population of SCLC patients.

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Section: Discussionmentioning

confidence: 99%

Exploration of spatial distribution of brain metastasis from small cell lung cancer and identification of metastatic risk level of brain regions: a multicenter, retrospective study

et al. 2021

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“…These 2 confounders would bias the results towards the null hypothesis. The SEER database did not include information such as prophylactic cranial irradiation, which had been established to have a positive impact on survival of patients with limited-stage SCLC [25, 26]. The lack of the information of prophylactic cranial irradiation would bias the results of the paper.…”

Section: Discussionmentioning

confidence: 99%

Propensity Score Matching Analysis for the Role of Surgery in Small Cell Lung Cancer

Wei

Tian

et al. 2020

Oncol Res Treat

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Background: The role of surgery for small cell lung cancer (SCLC) is not clear. We aimed to evaluate this issue using a population-based database. Methods: Patients diagnosed between 2004 and 2014 with SCLC staged T1–4 N0–2 M0 disease were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to reduce bias between the surgical and nonsurgical patient groups. The Kaplan-Meier method and Cox regression analysis were used to compare overall survival (OS) for the matched patients. Results: A total of 8,811 patients were retrieved, including 863 patients who underwent surgical resection. After 1:1 PSM, a matched cohort with 1,562 patients was generated. In the matched cohort, surgery was associated with 5-year OS improvement (from 16.8 to 36.7%, p < 0.001) and lung cancer-specific survival improvement (from 21.6 to 43.2%, p < 0.001). Survival benefits of surgery were significant in all subgroups, including N1–2 disease, except for patients with a tumor size >5.0 cm or T3 disease. Conclusions: Patients with SCLC of limited stage can benefit from surgery, including N1–2 disease. However, patients with a tumor size >5.0 cm or advanced T stage may be unable to benefit from surgery.

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“…As an example, for patients with small cell lung cancer (SCLC), prophylactic cranial irradiation (PCI) not only reduces the risk of brain metastasis forming, but also improves both overall survival and disease-free survival where complete remission is achieved through systemic chemotherapy (30). However, there is a growing body of concern that some patients may experience unnecessary harm from adverse effects of PCI exposure, where there is minimal risk of future intracranial relapse (31). Detection of micrometastatic disease using VCAM-MPIO MRI would allow stratification of patients into a susceptible group likely to derive benefit from prophylactic treatment strategies and those who should remain under observation.…”

Section: Discussionmentioning

confidence: 99%

VCAM-1–targeted MRI Enables Detection of Brain Micrometastases from Different Primary Tumors

Cheng

Soto

Khrapitchev

et al. 2019

Clinical Cancer Research

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Purpose: A major issue for the effective treatment of brain metastasis is the late stage of diagnosis with existing clinical tools. The aim of this study was to evaluate the potential of vascular cell adhesion molecule 1 (VCAM-1)-targeted MRI for early detection of brain micrometastases in mouse models across multiple primary tumor types.Experimental Design: Xenograft models of brain micrometastasis for human breast carcinoma (MDA231Br-GFP), lung adenocarcinoma (SEBTA-001), and melanoma (H1_DL2) were established via intracardiac injection in mice. Animals (n ¼ 5-6/group) were injected intravenously with VCAM-1targeted microparticles of iron oxide (VCAM-MPIO) and, subsequently, underwent T 2 Ã -weighted MRI. Control groups of na€ ve mice injected with VCAM-MPIO and tumor-bearing mice injected with nontargeting IgG-MPIO were included.Results: All models showed disseminated micrometastases in the brain, together with endothelial VCAM-1 upregulation across the time course. T 2 Ã -weighted MRI of all tumor-bearing mice injected with VCAM-MPIO showed significantly more signal hypointensities (P < 0.001; twosided) than control cohorts, despite a lack of blood-brain barrier (BBB) impairment. Specific MPIO binding to VCAM-1-positive tumor-associated vessels was confirmed histologically. VCAM-1 expression was demonstrated in human brain metastasis samples, across all three primary tumor types.Conclusions: VCAM-1-targeted MRI enables the detection of brain micrometastases from the three primary tumor types known to cause the majority of clinical cases. These findings represent an important step forward in the development of a broadly applicable and clinically relevant imaging technique for early diagnosis of brain metastasis, with significant implications for improved patient survival.

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Prophylactic Cranial Irradiation for Resectable Small-Cell Lung Cancer

Cited by 11 publications

References 23 publications

Exploration of spatial distribution of brain metastasis from small cell lung cancer and identification of metastatic risk level of brain regions: a multicenter, retrospective study

Exploration of spatial distribution of brain metastasis from small cell lung cancer and identification of metastatic risk level of brain regions: a multicenter, retrospective study

Propensity Score Matching Analysis for the Role of Surgery in Small Cell Lung Cancer

VCAM-1–targeted MRI Enables Detection of Brain Micrometastases from Different Primary Tumors

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