Cranial irradiation in small cell lung cancer

Gregor, A.

doi:10.1038/bjc.1991.5

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Although it is well established that PCI reduces the likeli-hood of cranial recurrence, 10,12,13,17 to our knowledge the current study is 1 of the few studies that reveals an improvement in OS and is the first study to report that this improvement persists at 10 years. These favorable survival results are consistent with other studies that evaluated PCI in patients with limited stage small cell lung cancer, including the studies by Auperin et al and Arriagada et al, which revealed a 2-year OS rate of 22% versus 29% in the treatment group and the meta-analysis for which the 3-year OS rate increased from 15.3% to 20.7%.…”

Section: Discussionmentioning

confidence: 75%

“…Although it is well established that PCI reduces the likelihood of cranial recurrence, 10,12,13,17 to our knowledge the current study is 1 of the few studies that reveals an improvement in OS and is the first study to report that this improvement persists at 10 years. These favorable survival results are consistent with other studies that evaluated PCI in patients with limited stage small cell lung cancer, including the studies by Auperin et al and Arriagada et al, which revealed a 2-year OS rate of 22% versus 29% in the treatment group and the meta-analysis for which the 3-year OS rate increased from 15.3% to Whereas the benefit in survival was noted in this most recent European Organization for Research and Treatment of Cancer (EORTC) PCI study, it is worth noting that this study has limitations, including the finding that brain imaging was not required before patient study participation and that the radiation dose regimens used would, by US standards, be considered definitive and not prophylactic.…”

Section: Discussionmentioning

confidence: 84%

“…Many of those studies and subsequent meta-analyses reported a reduced risk of symptomatic brain metastasis with PCI and improved survival. [9][10][11][12] The meta-analysis reported by Auperin et al, which included 7 trials, 1 with unpublished data, demonstrated an absolute improvement in survival from 15.3% to 20.7% at 3 years. 9 The 5.4% benefit represents a >30% improvement in survival for the treated versus nontreated group.…”

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confidence: 99%

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Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer

Patel

Macdonald

Suntharalingam

2009

Cancer

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BACKGROUND: Prophylactic cranial irradiation has been used in patients with small cell lung cancer to reduce the incidence of brain metastasis after primary therapy. The purpose of this study was to evaluate the effects of prophylactic cranial irradiation (PCI) on overall survival and cause‐specific survival. METHODS: A total of 7995 patients with limited stage small cell lung cancer diagnosed between 1988 and 1997 were retrospectively identified from centers participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Of them, 670 were identified as having received PCI as a component of their first course of therapy. Overall survival and cause‐specific survival were estimated by the Kaplan‐Meier method, comparing patients treated with or without prophylactic whole‐brain radiotherapy. The Cox proportional hazards model was used in the multivariate analysis to evaluate potential prognostic factors. RESULTS: The median follow‐up time was 13 months (range, 1 month to 180 months). Overall survival at 2 years, 5 years, and 10 years was 23%, 11%, and 6%, respectively, in patients who did not receive PCI. In patients who received PCI, the 2‐year, 5‐year, and 10‐year overall survival rates were 42%, 19%, and 9%, respectively (P = <.001). The cause‐specific survival rate at 2 years, 5 years, and 10 years was 28%, 15%, 11%, respectively, in patients who did not receive PCI and 45%, 24%, 17%, respectively, in patients who did receive PCI (P = <.001). On multivariate analysis of cause‐specific and overall survival, age at diagnosis, sex, grade, extent of primary disease, size of disease, extent of lymph node involvement, and PCI were found to be significant (P = <.001). The hazards ratios for disease‐specific and all cause mortality were 1.13 and 1.11, respectively, for those not receiving PCI. CONCLUSIONS: Significantly improved overall and cause‐specific survival was observed in patients treated with prophylactic cranial irradiation on unadjusted and adjusted analyses. This study concurs with the previously published European experience. Prophylactic cranial irradiation should be considered for patients with limited stage small cell lung cancer. Cancer 2009. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 84%

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Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer

Patel

Macdonald

Suntharalingam

2009

Cancer

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“…The long-term sequelae of PCI have been reduced substantially by using conventionally fractionated irradiation and by delaying PCI until after the delivery of chemotherapy. In clinical trials of the usefulness of PCI that included prospective neurologic and neuropsychometric assessment, no significant detriment could be attributed to PCI at the dose schedule used (52). The cumulative risk of CNS failure may be as high as 50%-60% (50).…”

Section: Radiation Oncologist's Viewmentioning

confidence: 99%

Oncodiagnosis Panel: 1999

Komaki

Chasen

Travis³

et al. 2001

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Topoisomerase expression in cancer cell lines and clinical samples

Doyle

1994

Cancer Chemother. Pharmacol.

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Topoisomerase II activity has been previously associated with chemosensitivity to cytotoxic agents in cell lines made resistant to drugs in vitro. Examination of unselected cancer cell lines, however, shows a relatively poor correlation between topoisomerase II content and intrinsic chemoresistance. Studies of topoisomerase II expression in clinical materials from human tumor biopsies also demonstrate a poor relationship with the response of the cancers to induction chemotherapy. A major problem with assessing topoisomerase II activity in clinical materials is the marked heterogeneity of the enzyme among the cells and the associated high proportion of tumor cells which are not traversing the cell cycle. While the activation of oncogenes may disregulate topoisomerase II expression in some experimental systems, there is currently no evidence that enzyme activity is disconnected from cell cycling in clinical cancer specimens. Novel techniques of topoisomerase II measurement may permit more accurate correlation of enzyme activity with clinical chemosensitivity.

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Cranial irradiation in small cell lung cancer

Cited by 7 publications

References 22 publications

Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer

Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer

Oncodiagnosis Panel: 1999

Topoisomerase expression in cancer cell lines and clinical samples

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