Controlled clinical trial of prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission

Laplanche, Agnès; Monnet, I.; Santos-Miranda, J. A.; Bardet, É.; Péchoux, C. Le; Tarayre, Michèle; Arriagada, R.

doi:10.1016/s0169-5002(98)00056-7

Cited by 79 publications

(40 citation statements)

References 32 publications

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“…The use of prophylactic cranial irradiation (PCI) has consistently been shown to be effective in decreasing the incidence of CNS failures [42][43][44][45], and it is recommended therapy for patients with LS-SCLC who have had a complete response to primary therapy. Historically, the routine use of PCI was met with skepticism because of retrospective reports of a high level of toxicity and a lack of a survival advantage.…”

Section: Prophylactic Cranial Irradiationmentioning

confidence: 99%

Limited-Stage Small Cell Lung Cancer: Current Chemoradiotherapy Treatment Paradigms

Stinchcombe

Gore

2010

The Oncologist

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In the U.S., the prevalence of small cell lung cancer (SCLC) is declining, probably reflecting the decreasing prevalence of tobacco use. However, a significant number of patients will receive a diagnosis of SCLC, and approximately 40% of patients with SCLC will have limited-stage (LS) disease, which is potentially curable with the combination of chemotherapy and radiation therapy. The standard therapy for LS-SCLC is concurrent chemoradiotherapy, and the 5-year survival rate observed in clinical trials is approximately 25%. The standard chemotherapy remains cisplatin and etoposide, but carboplatin is frequently used in patients who cannot tolerate or have a contraindication to cisplatin. Substantial improvements in survival have been made through improvements in radiation therapy. Concurrent chemoradiotherapy is the preferred therapy for patients who are appropriate candidates. The optimal timing of concurrent chemoradiotherapy is during the first or second cycle, based on data from meta-analyses. The optimal radiation schedule and dose remain topics of debate, but 1.5 Gy twice daily to a total of 45 Gy and 1.8 -2.0 Gy daily to a total dose of 60 -70 Gy are commonly used treatments. For patients who obtain a near complete or complete response, prophylactic cranial radiation reduces the incidence of brain metastases and improves overall survival. The ongoing Radiation Therapy Oncology Group and Cancer and Leukemia Group B and the European and Canadian phase III trials will investigate different radiation treatment paradigms for patients with LS-SCLC, and completion of these trials is critical.

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Section: Prophylactic Cranial Irradiationmentioning

confidence: 99%

Limited-Stage Small Cell Lung Cancer: Current Chemoradiotherapy Treatment Paradigms

Stinchcombe

Gore

2010

The Oncologist

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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%

“…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%

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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“…Survival after occurrence of brain metastases is short: median 3-6 months, although long-term survival can be seen in patients, who remain in systemic remission [32]. The rate of brain metastases occurring in complete responders after conclusion of chemotherapy can be reduced significantly if cranial irradiation: 24-36 Gy is given prophylacticly [17,22,33] but an observed positive impact on overall survival was not statistically significant in these trials. This problem was solved with a meta-analysis published in 1999 [5].…”

Section: Prophylactic Cranial Irradiationmentioning

confidence: 93%

Chemotherapy in small cell lung cancer

Østerlind¹

2001

Eur Respir J

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Chemotherapy is the backbone in the treatment of small cell lung cancer (SCLC) and radiotherapy is an important adjunct in limited stage disease. The role of chest irradiation is now documented in three meta-analysis, based on the same body of data. Trials on timing, scheduling and fractionation could have followed a more stringent development line but altogether, the highest efficacy seems to be obtained with early, concurrent twice-daily chest irradiation. Patients in complete remission should have prophylactic cranial irradiation, which reduces the risk of brain metastases and of death from SCLC.Four series of chemotherapy seem to be sufficient in limited-stage disease while six is recommended in extensive disease. The combination of etoposide plus cis- or carboplatin is appropriate in both stages and addition of other agents has no clinically important impact on the survival. Use of haematological growth factors such as granulocyte colony stimulating factor (G-CSF) and granulocyte macrophage colony stimulating factor (GM-CSF) may enable higher doses or more frequent dosage. Three randomized trials on GM-CSF showed a negative outcome while G-CSF support may result in better survival rates, but a more cost-efficient policy must be found. High-dose chemotherapy plus haematological stem-cell support is still under investigation but disappointing long-term survival rates means there is not much optimism for this strategy.New strategies in general are requested in the treatment of extensive-stage disease and of elderly patients. Phase II trials suggest that good-risk patients with extensive disease should be treated aggressively, intermediate-risk patients more gently, and palliation must be the primary aim in the treatment of poor-risk patients. In elderly patients impressive survival rates are obtained with 3–4 series of chemotherapy and radiation delivered in 5–10 fractions.A number of new agents are active but more trials are required before each has found a place, if any, in the treatment of small cell lung cancer. To conclude, the randomized trial is still an important instrument in clinical oncology, and trials in small cell lung cancer must be large, which is why the cooperation of organizations and multicentres is urgent.

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Controlled clinical trial of prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission

Cited by 79 publications

References 32 publications

Limited-Stage Small Cell Lung Cancer: Current Chemoradiotherapy Treatment Paradigms

Limited-Stage Small Cell Lung Cancer: Current Chemoradiotherapy Treatment Paradigms

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

Chemotherapy in small cell lung cancer

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