Comparative study of prophylactic cranial irradiation in patients with small cell lung cancer achieving a complete response: a long-term follow-up result

Ohonoshi, Taisuke; Ueoka, Hiroshi; Kawahara, Satoshi; Kiura, Katsuyuki; Kamei, Haruhito; Hiraki, Yoshio; Segawa, Yoshihiko; Hiraki, Shunkichi; Kimura, Ikuo

doi:10.1016/0169-5002(93)90308-k

Cited by 76 publications

(36 citation statements)

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“…This approach is supported by the previous successful application of PCI regimens using conventional 2-Gy fractions. 31,32 In conclusion, we recommend treating patients who have NSNEC with induction chemotherapy followed by RT alone for complete responders. Concurrent chemoradiotherapy does not necessary appear to improve early complete response, local control, or survival, and it is a more toxic induction technique.…”

Section: Discussionmentioning

confidence: 99%

Management of nonsinonasal neuroendocrine carcinomas of the head and neck

Barker¹,

Glisson²,

Garden³

et al. 2003

Cancer

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BACKGROUNDNonsinonasal neuroendocrine carcinomas (NSNEC) of the head and neck are rare and pose a diagnostic and management challenge. The authors undertook a retrospective study to gain insights into the spectrum of clinicopathologic characteristics, patterns of failure, and optimal management of patients with this disease.METHODSThe authors treated 23 adults with pathologically proven, nonmetastatic, primary NSNEC from 1984 to 2001. The majority (13 patients) had laryngeal origin with the following American Joint Committee on Cancer stage distribution: Stage I disease in 1 patient, Stage II disease in 2 patients, Stage III disease in 6 patients, and Stage IV disease in 14 patients. Nine patients underwent definitive surgery with or without postoperative radiation, and 14 patients received definitive radiotherapy. The median definitive radiation dose was 66 grays (Gy) (range, 44–72 Gy) using conventional fractionation. Fourteen patients received chemotherapy, with two to four cycles of induction platinum plus etoposide used most commonly.RESULTSThe median follow‐up time for surviving patients was 40 months (range, 15–89 months). The actuarial 2‐year and 5‐year overall survival (OS) rates were 53% and 33%, respectively; and the disease‐free survival (DFS) rates were 41% and 25%, respectively. Both the 2‐year OS rate (68% vs. 30%; P = 0.002) and the 2‐year DFS rate (55% vs. 17%; P = 0.004) were improved with chemotherapy compared with local therapy alone. Seventy‐five percent of patients with measurable disease had complete clinical responses to induction chemotherapy. There was 100% complete clinical response of tumor after radiotherapy. The actuarial 2‐year local failure rate was 23%. Chemotherapy did not reduce local failure (P = 0.91). There was no regional failure. The 2‐year and 5‐year distant metastasis rates were 54% and 71%, respectively. The 2‐year rates of metastases without and with chemotherapy were 79% and 39%, respectively (P = 0.006). The 2‐year and 5‐year rates of intracranial metastases were 25% and 44%, respectively, and the 2‐year and 5‐year rates of isolated brain metastases were 21% and 41%, respectively.CONCLUSIONSBased on these results, the authors' treatment strategy for patients with NSNEC is sequential chemotherapy and radiation. They recommend full‐dose radiotherapy alone for patients with NSNEC who achieve a complete clinical response to induction chemotherapy. Newer chemotherapeutic regimens or additional adjuvant chemotherapy should be investigated for patients with NSNEC given the high rate of distant failure. Due to the very high rate of brain metastases among patients in the current study, the authors now consider incorporating prophylactic cranial irradiation into primary radiotherapy for individual patients who have complete clinical responses to induction chemotherapy. Cancer 2003. © 2003 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Management of nonsinonasal neuroendocrine carcinomas of the head and neck

Barker¹,

Glisson²,

Garden³

et al. 2003

Cancer

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“…A total of 16 RCTs, (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) published between 1977 and 2007, were considered eligible for inclusion in the present study. The principal characteristics of those RCTs are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 5 studies (6,9,(12)(13)(14) evaluated the role of PCI administered at the start of induction chemotherapy in patients considered free of brain metastases. A total of 7 studies (894 patients) (4,5,7,11,15) evaluated the role of PCI in patients who received it during induction chemotherapy. In 2 studies, (6,8) PCI was given as consolidation therapy at the end of chemotherapy, before the response had been evaluated.…”

Section: Resultsmentioning

confidence: 99%

“…Of those, 1,021 were randomized to the PCI group and 962 were randomized to the control group. A total of 7 studies (894 patients) (4,5,7,11,15) evaluated the role of PCI in patients who had a complete response after induction chemotherapy. A total of 5 studies (6,9,(12)(13)(14) evaluated the role of PCI administered at the start of induction chemotherapy in patients considered free of brain metastases.…”

Section: Resultsmentioning

confidence: 99%

“…On the basis of the abovementioned data, several randomized clinical trials (RCTs) have investigated the role of prophylactic cranial irradiation (PCI) in patients with extensive or limited SCLC. (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) A meta-analysis published in 1999 and including 7 RCTs involving 987 patients with SCLC and complete response to chemotherapy showed a 5.4% increase in the three-year survival of those undergoing PCI. (20) However, ever since that meta-analysis was published, several RCTs have been published, and uncertainties still remain regarding the indications for PCI use in patients with extensive disease and in those with limited disease and an incomplete response to chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Trinta anos de irradiação craniana profilática em pacientes com câncer de pulmão de pequenas células: uma meta-análise de ensaios clínicos randomizados

et al. 2012

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Objective: To determine the role of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC). Methods: We searched various databases, selecting randomized clinical trials published in journals or conference proceedings within the last 30 years and investigating the role of PCI in the mortality of patients with SCLC, submitted to PCI or not. Results: Sixteen randomized clinical trials, collectively involving 1,983 patients, were considered eligible for inclusion. Of those 1,983 patients, 1,021 were submitted to PCI and 962 were not. Overall mortality was 4.4% lower in the patients submitted to PCI than in those who were not Descritores: Carcinoma de pequenas células do pulmão; Radioterapia; Análise de sobrevida.

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