Prophylactic cranial irradiation in patients with small-cell lung cancer: the experience at the Institute of Oncology Ljubljana

Stanič, Karmen; Kovač, Viljem

doi:10.2478/v10019-010-0038-4

Cited by 11 publications

(17 citation statements)

References 22 publications

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“…might be due to the relatively small number of patients with brain metastases in both trials as well as due to possible differences in other patients’ characteristics. It is well known that the extent of the disease, characterized by performance status, LDH levels and the number of metastatic sites, determines the prognosis of ED even more than the site of metastases 16–19. The percentage of patients with brain metastases in our collective of patients was rather low (13.5%) which might be the consequence of our selection criteria, i.e.…”

Section: Discussionmentioning

confidence: 83%

“…It was followed by a large EORTC (European Organisation for Research and Treatment of Cancer) trial that confirmed significant benefit of PCI in all patients achieving response (complete or partial) to first-line systemic therapy 25. Based on these observations PCI represents a standard treatment approach nowadays, which ultimately results in a lower rate of brain metastases diagnosed during the course of the disease 19. However, the percentage of patients presenting with brain metastases at the time of diagnosis remains stable, i.e .…”

Section: Discussionmentioning

confidence: 97%

“…performance status equal or less than 2. Performance status was found to be correlated with the extent of disease as well as CNS involvement 17,19…”

Section: Discussionmentioning

confidence: 99%

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Outcome of small cell lung cancer (SCLC) patients with brain metastases in a routine clinical setting

Lekic¹,

Kovač²,

Triller³

et al. 2012

Radiology and Oncology

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BackgroundSmall cell lung cancer (SCLC) represents approximately 13 to 18% of all lung cancers. It is the most aggressive among lung cancers, mostly presented at an advanced stage, with median survival rates of 10 to12 months in patients treated with standard chemotherapy and radiotherapy. In approximately 15-20% of patients brain metastases are present already at the time of primary diagnosis; however, it is unclear how much it influences the outcome of disease according the other metastatic localisation. The objective of this analysis was to evaluate the median survival of SCLC patients treated by specific therapy (chemotherapy and/or radiotherapy) with regard to the presence or absence of brain metastases at the time of diagnosis.Patients and methodsAll SCLC patients have been treated in a routine clinical practice and followed up at the University Clinic Golnik in Slovenia. In the retrospective study the medical files from 2002 to 2007 were review. All patients with cytological or histological confirmed disease and eligible for specific oncological treatment were included in the study. They have been treated according to the guidelines valid at the time. Chemotherapy and regular followed-up were carried out at the University Clinic Golnik and radiotherapy at the Institute of Oncology Ljubljana.ResultsWe found 251 patients eligible for the study. The median age of them was 65 years, majority were male (67%), smokers or ex-smokers (98%), with performance status 0 to 1 (83%). At the time of diagnosis no metastases were found in 64 patients (25.5%) and metastases outside the brain were presented in 153 (61.0%). Brain metastases, confirmed by a CT scan, were present in 34 patients (13.5%), most of them had also metastases at other localisations. All patients received chemotherapy and all patients with confirmed brain metastases received whole brain irradiation (WBRT). The radiotherapy with radical dose at primary tumour was delivered to 27 patients with limited disease and they got 4–6 cycles of chemotherapy. Median overall survival (OS) of 34 patients with brain metastases was 9 months (95% CI 6–12) while OS of 153 patients with metastases in other locations was 11 months (95% CI 10–12); the difference did not reach the level of significance (p = 0.62). As expected, the OS of patients without metastases at the time of primary diagnosis turned out to be significantly better compared to the survival of patients with either brain or other location metastases at the primary diagnosis (15 months vs 9 and 11 months, respectively, p < 0.001).ConclusionsIn our investigated population, the prognosis of patients with extensive SCLS with brain metastases at the primary diagnosis treated with chemotherapy and WBRT was not significantly worse compared to the prognosis of patients with extensive SCLC and metastases outside the brain. In extensive SCLC brain metastases were not a negative prognostic factor per se if the patients were able to be treated appropriately. However, the survival rates of extensive SCLC with or without...

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 97%

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Outcome of small cell lung cancer (SCLC) patients with brain metastases in a routine clinical setting

Lekic¹,

Kovač²,

Triller³

et al. 2012

Radiology and Oncology

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“…A recent retrospective report also indicated a 25% incidence in the development of brain metastasis after PCI (22,23). Moreover, when PCI was not performed for patients with completely surgically resected SCLC, the actuarial risk of developing brain metastasis was reportedly 13.8% at 1 year and 23.0% at 3 years (18).…”

Section: Discussionmentioning

confidence: 98%

Treatment outcomes of patients with small cell lung cancer without prophylactic cranial irradiation

et al. 2016

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Background: Prophylactic cranial irradiation (PCI) is indicated for limited disease (LD) in small cell lung cancer (SCLC) patients who achieve a complete or near-complete response; however, it is sometimes not administered because of possible adverse reactions or patient refusal. Here we assessed treatment outcomes among patients with SCLC who were not treated with PCI. Conclusions:The results of our study demonstrated that the outcomes of treatment without PCI were improved, as compared with those of previously published data. Our findings may be used as reference data when PCI cannot be performed.

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“…Survival after the whole brain radiation therapy ranges from 10 to 18 months, but was reported to rise to an average of 44 months following chemotherapy and radiation therapy, or chemotherapy alone 13–19. Yet, radiation therapy is associated with a high incidence of neurotoxicity, which is however not seen after the radiation therapy of patients with brain metastases of solid tumors because of their shorter survival or lower tumor dose 20. Although currently available therapeutic regimes prolong the survival, they are in contrast to therapies used to treat systemic lymphomas,21,22 not curative in most patients.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes and survival in patients with primary central nervous system lymphomas treated between 1995 and 2010 – a single centre report

Novaković¹

2012

Radiology and Oncology

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Background.Primary central nervous system lymphomas (PCNSL) are rare variants of extranodal non-Hodgkin’s lymphomas that are nowadays primarily treated with high-dose methotrexate or methotrexate-based chemotherapy with or without radiation therapy. The optimal treatment of PCNSL is still unknown and there are differences in clinical practice.Patients and methods.With a retrospective research we evaluated our series of patients with PCNSL in regards to the patient’s characteristics, treatment results, disease specific survival and overall survival. Fifty nine patients who attended the Institute of Oncology Ljubljana between 1995 and 2010 were treated according to the protocol that was valid at the time of the patient’s admission. Between 1995 and 1999, the systemic treatment was classical CHOP (cyclophosphamide, doxorubicin, vincristine, steroids) chemotherapy, and later on high-dose methotrexate either alone or in combination with other agents. From 1999 onwards, radiation therapy was applied according to the patient’s age and response to chemotherapy, prior to that all patients treated with CHOP were also irradiated. Patients ineligible for the systemic treatment were treated with sole radiation therapy.Results.There was a strong female predominance in our series and the median age at diagnosis was 59.8 years. Patients had predominantly aggressive B cell lymphomas (69.5%), one patient had marginal cell lymphoma and two patients T cell lymphoma. In total, 20.3% of patients were treated just with chemotherapy, 33.9% with combined therapy and 42.4% with sole radiation therapy. The overall response rate to the primary treatment in patients treated with sole chemotherapy was 33.3%, in patients treated with combined therapy 65% and in patients treated only with radiation therapy 56%, respectively. In terms of response duration, significantly better results were achieved with combined therapy or radiation therapy alone compared to sole chemotherapy (p<0.0006). The median overall survival of the whole cohort was 11 months and the overall survival was significantly affected by the patient’s age. The longest overall survival was observed in patients treated with combined therapy (median survival of 39 months). Patients treated just with radiation therapy had a median overall survival of 9 months and those treated with sole chemotherapy of 4.5 months, respectively.Conclusions.The treatment outcomes in ordinary clinical practice are definitely inferior to the ones reported in clinical trials. The now standard treatment with high-dose methotrexate with or without radiation therapy is sometimes too aggressive and, therefore, a careful selection on the basis of patient’s age, performance status and concomitant diseases of those eligible for such treatment is mandatory. According to our results from a retrospective study, radiation therapy should not be excluded from the primary treatment.

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Prophylactic cranial irradiation in patients with small-cell lung cancer: the experience at the Institute of Oncology Ljubljana

Cited by 11 publications

References 22 publications

Outcome of small cell lung cancer (SCLC) patients with brain metastases in a routine clinical setting

Outcome of small cell lung cancer (SCLC) patients with brain metastases in a routine clinical setting

Treatment outcomes of patients with small cell lung cancer without prophylactic cranial irradiation

Treatment outcomes and survival in patients with primary central nervous system lymphomas treated between 1995 and 2010 – a single centre report

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