Prophylactic cranial irradiation or MRI surveillance for extensive stage small cell lung cancer

Taylor, James M.; Rusthoven, Chad G.; Moghanaki, Drew

doi:10.21037/jtd.2020.03.80

Cited by 9 publications

(7 citation statements)

References 46 publications

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“…For the broader question whether we should still be describing PCI altogether, or should adapt a strategy of MRI surveillance, we refer to a recent review on this matter. 50 Several limitations should be noted for the current study. We did not directly explore the (individually variable) locations of hot spots and their association with MRI measures at these specific locations.…”

Section: Discussionmentioning

confidence: 93%

Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI

et al. 2022

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Background Reducing radiation dose to the hippocampus with hippocampal avoidance prophylactic cranial irradiation (HA-PCI) is proposed to prevent cognitive decline. It has, however, not been investigated whether hippocampal atrophy is actually mitigated by this approach. Here, we determined whether HA-PCI reduces hippocampal atrophy. Additionally we evaluated neurotoxicity of (HA-)PCI to other brain regions. Finally, we evaluated associations of hippocampal atrophy and brain neurotoxicity with memory decline. Methods High quality research MRI scans were acquired in the multicenter, randomized phase 3 trial NCT01780675. Hippocampal atrophy was evaluated 4 months (57 HAPCI patients and 46 PCI patients) and 12 months (28 HAPCI patients and 27 PCI patients) after (HA-)PCI. We additionally studied multimodal indices of brain injury. Memory was assessed with the Hopkins Verbal Learning Test Revised (HVLT-R). Results HA-PCI reduced hippocampal atrophy at 4 months (1.8% for HA-PCI and 3.0% for PCI) and at 12 months (3.0% for HA-PCI and 5.8% for PCI). Both HA-PCI and PCI were associated with considerable reductions of gray matter and normal appearing white matter, increases of white matter hyperintensities and brain aging. There were no significant associations between hippocampal atrophy and memory. Conclusions HA-PCI reduces hippocampal atrophy at 4 and 12 months compared to regular PCI. Both types of radiotherapy are associated with considerable brain injury. We did not find evidence for excessive brain injury after HA-PCI relative to PCI. Hippocampal atrophy was not associated with memory decline in this population as measured with HVLT-R. The usefulness of HA-PCI is still subject to debate.

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Section: Discussionmentioning

confidence: 93%

Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI

et al. 2022

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“…Furthermore, PCI, for extensive-stage small-cell lung cancer, is nowadays a controversial area after the publication of the results of a Japanese trial [ 165 ] questioning the survival benefit after PCI in subjects with extensive-stage small-cell lung cancer [ 166 , 167 ]. In particular, it is believed that PCI needs to be reconsidered, given the negative impact on cognition and, at the same time, the growing role of MRI surveillance and anti-check point agents [ 168 , 169 , 170 , 171 , 172 , 173 ].…”

Section: Resultsmentioning

confidence: 99%

Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review

Scampoli

Cammelli

Galietta

et al. 2022

Cancers

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Preserving cognitive functions is a priority for most patients with brain metastases. Knowing the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline (CD) led to testing both the antiglutamatergic pharmacological prophylaxis and hippocampal-sparing whole-brain radiotherapy (WBRT) techniques. These studies showed a relative reduction in CD four to six months after WBRT. However, the failure to achieve statistical significance in one study that tested memantine alone (RTOG 0614) led to widespread skepticism about this drug in the WBRT setting. Moreover, interest grew in the reasons for the strong patient dropout rates in the first few months after WBRT and for early CD onset. In fact, the latter can only partially be explained by subclinical tumor progression. An emerging interpretation of the (not only) cognitive impairment during and immediately after WBRT is the dysfunction of the limbic and hypothalamic system with its immune and hormonal consequences. This new understanding of WBRT-induced toxicity may represent the basis for further innovative trials. These studies should aim to: (i) evaluate in greater detail the cognitive effects and, more generally, the quality of life impairment during and immediately after WBRT; (ii) study the mechanisms producing these early effects; (iii) test in clinical studies, the modern and advanced WBRT techniques based on both hippocampal-sparing and hypothalamic-pituitary-sparing, currently evaluated only in planning studies; (iv) test new timings of antiglutamatergic drugs administration aimed at preventing not only late toxicity but also acute effects.

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“…Therefore, asymptomatic yet radiologically detectable brain metastases could be included in the EORTC trial and contribute to the positive results. 49 Subsequently, a Japanese phase III randomized trial compared PCI and magnetic resonance imaging (MRI) monitoring in 224 patients and required brain MRI evaluation before recruitment and after follow-up, which ensured detectable brain metastases and the timely detection of brain metastasis progression. 50 Patients with ES-SCLC who did not have brain metastases confirmed by MRI did not experience a statistically significant increase in OS with the use of PCI (p = 0.094).…”

Section: Progress Of Pci and Srsmentioning

confidence: 99%

“…In contrast, ICIs are capable of stimulating T cells peripherally to, in turn, have antitumoral effects in the CNS, thus diluting the benefit of PCI or even whole-brain radiotherapy. 49,57 The results of multiple meta-analyses [58][59][60] established PCI as the standard of regimen for LS-SCLC. Auperin et al 59 analyzed the data of 987 patients in seven randomized trials.…”

Section: Progress Of Pci and Srsmentioning

confidence: 99%

Progress in radiotherapy for small‐cell lung cancer

Yang,

Zhao

2023

Precision Radiation Oncology

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Small‐cell lung cancer (SCLC) is a highly aggressive neuroendocrine tumor that is prone to spread extensively. Compared to non‐small‐cell lung cancer (NSCLC), SCLC treatment progresses slowly. Although SCLC is highly sensitive to chemotherapy during the initial treatment, most patients still experience resistance and recurrence after receiving chemotherapy. A meta‐analysis demonstrated that thoracic radiotherapy (TRT) improves overall survival in SCLC. The results of the CALGB and CONVERT trials provide evidence for the efficacy of once‐daily high‐dose TRT. TRT at 60 Gy administered twice daily significantly improved survival without increasing toxicity. The long‐standing debate over the optimal timing of radiotherapy has not been fully resolved. SBRT has excellent local control rates and is a safe and effective treatment option for patients with stage I or II SCLC. Prophylactic cranial irradiation (PCI) is used to reduce treatment‐related neurotoxicity to the extent that there has been a recent discussion on whether magnetic resonance imaging (MRI) monitoring can replace PCI. Radiotherapy combined with immunotherapy significantly improves the survival rate of patients with NSCLC; however, its clinical effectiveness has not been systematically explored in patients with SCLC. Therefore, we summarize the evolving therapeutic strategies, (TRT for limited stage‐SCLC and consolidative TRT for extensive stage‐SCLC) and improved radiotherapy techniques (role of SBRT in stage I or II node‐negative SCLC, progress of PCI, and stereotactic radiosurgery), and discuss the possibilities and prospects of radiotherapy combined with immunotherapy for SCLC.

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Prophylactic cranial irradiation or MRI surveillance for extensive stage small cell lung cancer

Cited by 9 publications

References 46 publications

Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI

Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI

Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review

Progress in radiotherapy for small‐cell lung cancer

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