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

Sakaguchi, Masakuni; Maebayashi, Toshiya; Aizawa, Takuya; Ishibashi, Naoya; Saito, Tsutomu

doi:10.21037/jtd.2016.08.73

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…There is little published information available on the survival outcomes and prognostic factors of patients who decline PCI, in the recent clinical situations in which PCI is accepted as a standard treatment for LS-SCLC. A retrospective study that reported treatment outcomes of 60 LS-SCLC patients who did not receive PCI after a CR or near-CR showed that brain metastasis, performance status, and T-stage were significantly related to OS [13]. Another recent study that performed a multivariate analysis with 153 patients reported that high T-stage, high neutrophil-to-lymphocyte ratio, early thoracic radiotherapy, and fewer chemotherapy cycles were risk factors for brain metastasis [12].…”

Section: Resultsmentioning

confidence: 99%

“…To our knowledge, only a few reports on the treatment outcomes of patients who did not receive PCI have been published according to current medical treatments [12,13]. An understanding of the treatment outcomes and prognostic factors may be helpful in deciding whether or not to apply PCI to patients with comorbidity, despite a good response to initial therapy.…”

Section: Introductionmentioning

confidence: 99%

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The value of prophylactic cranial irradiation in limited-stage small cell lung cancer: should it always be recommended?

Koh

Song

et al. 2019

Radiat Oncol J

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Purpose: Prophylactic cranial irradiation (PCI) is a standard treatment for limited-stage small cell lung cancer (LS-SCLC) showing a response to initial treatment, but many patients do not receive PCI due to comorbidities or refusal. This study aims to define the patient group for whom PCI can be omitted with minimal risk. Materials and Methods: Patients with LS-SCLC who underwent radiotherapy with curative aim at our institution between January 2004 and December 2015 were retrospectively reviewed. Patients who did not receive PCI were evaluated for brain metastasis-free survival (BMFS), progression-free survival (PFS), overall survival (OS), and prognostic factors for survival, and treatment outcomes were compared with a patient cohort who received PCI. Results: A total of 350 patients achieved a response following thoracic radiotherapy, and 190 of these patients did not receive PCI. Stage I-II and a complete response (CR) to initial therapy were good prognostic factors for BMFS and OS on univariate analysis. Patients with both stage I-II and a CR who declined PCI showed comparable 2-year BMFS to those who received PCI (92% vs. 89%). In patients who achieved CR, PCI did not significantly improve OS or PFS. Conclusion: There should be less concern about omitting PCI in patients with comorbidities if they have stage I-II or a CR, with brain metastasis control being comparable to those patients who receive PCI.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The value of prophylactic cranial irradiation in limited-stage small cell lung cancer: should it always be recommended?

Koh

Song

et al. 2019

Radiat Oncol J

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“…Furthermore, the rate of patients received PCI were relatively low. Although a recent study from Japan showed PCI played a detrimental role in the outcome of patients with LS-SCLC, 28 PCI is generally considered as a component of the treatment of patients with LS-SCLC. PFS and OS might be impaired by low PCI rate.…”

Section: Discussionmentioning

confidence: 99%

Sequential Versus Concurrent Thoracic Radiotherapy in Combination With Cisplatin and Etoposide for N3 Limited-Stage Small-Cell Lung Cancer

et al. 2020

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At present, concurrent chemoradiotherapy (CRT) is considered the standard treatment of limited-stage small cell lung cancer (LS-SCLC). However, LS-SCLC is highly heterogeneous in the T stage, N stage, and prognosis. Increasing evidence has shown that individual treatment should be considered when treating LS-SCLC patients. The aim of the present study was to explore the optimal combination model of thoracic radiotherapy (TRT) and chemotherapy in N3 LS-SCLC. We retrospectively analyzed 93 N3 LS-SCLC patients treated in the Department of Oncology of Binzhou Medical University Hospital (Shandong, China) between March 2010 and October 2015. A total of 52 (52/93; 55.9%) patients received sequential CRT, and 41 (41/93; 44.1%) patients received concurrent CRT. All patients received 4-6 cycles of chemotherapy and TRT (50-60 Gy). The median follow-up time was 25.4 months (range was 6-65 months).The overall response rate was 88.5% in the sequential CRT group (9.6% complete response rate and 78.8% partial response rate) and 90.2% in the concurrent CRT group (14.6% complete response rate and 75.6% partial response rate). The PFS and OS were 15.4 months and 19.1 months in sequential CRT group, and 16.9 months and 20.5 months in concurrent CRT group. There was no significant difference in treatment response rate, PFS, and OS between sequential and concurrent CRT patients. The most common treatment-related toxicities were nausea/vomiting, neutropenia, and esophagitis. In conclusion, when concurrent CRT is performed in N3 LS-SCLC patients, tolerance to treatment should be fully considered. In our study, sequential CRT and concurrent CRT showed the same efficacy, and sequential CRT demonstrated better tolerance. However, these results require confirmation in future follow-up studies.

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“…This was because the current standard of care in patients with LD-SCLC who have a good response to initial chemoradiotherapy is to receive PCI, although no individual randomized trial with PCI has demonstrated a significant OS prolongation for patients with LD-SCLC. Only few reports on patients with LD-SCLC who received standard chemoradiotherapy without PCI are available [ 35 – 37 ]. However, no studies about the clinical benefits of PCI in patients with LD-SCLC confirmed with no BM on MRI have been conducted.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of prophylactic cranial irradiation in patients with limited-disease small-cell lung cancer who were confirmed to have no brain metastasis via magnetic resonance imaging after initial chemoradiotherapy

et al. 2018

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BackgroundProphylactic cranial irradiation (PCI) is recommended for patients with limited-disease small-cell lung cancer (LD-SCLC) who achieved good response to definitive chemoradiotherapy. However, most clinical studies lacked brain imaging scans before PCI. Our study aimed to investigate whether PCI has a survival benefit in patients who have no brain metastases (BM) confirmed via magnetic resonance imaging (MRI) before PCI.ResultsEighty patients were included in this study. Sixty patients received PCI (PCI group) and 20 patients did not (non-PCI group). OS was not significantly different between the two groups. The median OS time was 4.3 years (95% CI: 2.6 years–8.6 years) in the PCI group and was not reached (NR) (95% CI: 1.9 years–NR) in the non-PCI group (p = 0.542). Moreover, no differences were observed in the 3-year rates of PFS (46.2% and 44.4%, p = 0.720) and cumulative incidence of BM (24.0% vs. 27%, p = 0.404).ConclusionsOur result suggests that PCI may not have a survival benefit in patients with LD-SCLC confirmed to have no BM after initial therapy, even if patients achieve a good response to definitive chemoradiotherapy.Patients and MethodsWe retrospectively evaluated patients with LD-SCLC who were confirmed to have no BM via MRI after initial chemoradiotherapy at the Shizuoka Cancer Center between September 2002 and August 2015. The overall survival (OS), progression-free survival (PFS), and cumulative incidence of BM were estimated using the Kaplan–Meier method between patients who received PCI and those who did not. Propensity score matching was used to balance baseline characteristics.

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

Cited by 8 publications

References 25 publications

The value of prophylactic cranial irradiation in limited-stage small cell lung cancer: should it always be recommended?

The value of prophylactic cranial irradiation in limited-stage small cell lung cancer: should it always be recommended?

Sequential Versus Concurrent Thoracic Radiotherapy in Combination With Cisplatin and Etoposide for N3 Limited-Stage Small-Cell Lung Cancer

Efficacy of prophylactic cranial irradiation in patients with limited-disease small-cell lung cancer who were confirmed to have no brain metastasis via magnetic resonance imaging after initial chemoradiotherapy

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