Factors Affecting the Risk of Brain Metastasis in Small Cell Lung Cancer With Surgery: Is Prophylactic Cranial Irradiation Necessary for Stage I-III Disease?

Gong, Lei; Wang, Q.I.; Zhao, Lujun; Li, Ruijian; Wang, Ping

doi:10.1016/j.ijrobp.2012.03.038

Cited by 58 publications

(42 citation statements)

References 17 publications

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“…[12–14] In one series from China, the investigators reported that the incidence of brain metastases was only 6% in patients with stage I SCLC, compared with 29% in patients with stage II–III SCLC. They concluded that patients with stage I SCLC may not require PCI after surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation

Gillis

Foster

et al. 2017

Radiotherapy and Oncology

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Background and Purpose The relationship between tumor-node-metastasis (TNM) stage and patterns of failure in limited-stage small cell lung cancer (LS-SCLC) remains unclear. We hypothesized that TNM stage predicts brain metastasis risk, and could inform the use of prophylactic cranial irradiation. Material and Methods We reviewed 283 patients with stage I–IIIB SCLC. Competing-risks regression was used to analyze local, distant, and brain failure. Multivariate analysis was used to evaluate the effect of treatment and clinical factors on failure and OS. Results Patients with stage I or II SCLC (35% of cohort) had significantly better survival and lower risk of distant and brain metastasis, compared with stage III patients. The 5-year cumulative incidence of brain metastasis for stage I/II and III were 12% and 26%, respectively. Stage had no correlation with local failure. On multivariate analysis, stage was independently prognostic for survival, distant metastasis risk, and brain metastasis risk. Conclusions TNM staging predicts likelihood of distant metastasis, brain metastasis, and survival in LS-SCLC. This supports the routine use of TNM staging in clinical practice. The lower risk of brain metastasis in stage I and II SCLC suggests that prophylactic cranial irradiation could play a more limited role in treatment of early-stage disease.

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Section: Discussionmentioning

confidence: 99%

Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation

Gillis

Foster

et al. 2017

Radiotherapy and Oncology

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“…Clinical data before 2014 in our institution showed that 19.5% of surgically resected SCLC patients suffered brain metastasis during the observation period . Additionally, the occurrence of brain metastases during p‐stage II and III disease was 28.2% (11/39) and 29.1% (16/55), respectively . Of the 146 p‐T1‐2N0M0 SCLC patients evaluated in the present study, 63 (43.2%) patients suffered from recurrence at a median of 27.5 months.…”

Section: Discussionmentioning

confidence: 57%

“…Gong et al . described the occurrence of brain metastases during p‐stage I disease at 6.25% (2/32) . The NCCN guidelines endorse concurrent chemotherapy and PCI for such patients based on evidence in limited stage SCLC patients .…”

Section: Discussionmentioning

confidence: 99%

Does surgically resected small‐cell lung cancer without lymph node involvement benefit from prophylactic cranial irradiation?

Lou

Zhong

et al. 2020

Thoracic Cancer

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Background It has previously been demonstrated that surgically resected small‐cell lung cancer (SCLC) patients could benefit from prophylactic cranial irradiation (PCI). However, PCI in patients without lymph node involvement remains controversial. This study includes a larger sample size to evaluate the benefit of PCI therapy in this specific population. Methods The records of surgically resected SCLC patients without lymph node involvement (N0M0) in Shanghai Chest Hospital were retrospectively reviewed. Results Between January 2006 and May 2017, a total of 146 cases of surgically resected SCLC without lymph node involvement were included. A total of 46 patients received PCI therapy and 100 patients received no therapy. During the observation period, 12.0% (12/100) of the patients who did not receive PCI therapy developed brain metastases while 10.9% (5/46) of patients who received PCI therapy developed brain metastases. With regard to time to recurrence, no significant difference was observed among the groups (P = 0.798). Moreover, there was no significant difference in either the overall survival benefit (hazard ratio [HR] = 0.84, 95% confidence interval [CI]: 0.49–1.45, P = 0.532) or disease‐free survival rate (HR = 0.95, 95% CI: 0.52–1.75, P = 0.864). Conclusions The evidence obtained does not support PCI therapy in the management of surgically resected SCLC with no lymph node involvement. Key points Prophylactic cranial irradiation (PCI) remains controversial for resected small‐cell lung cancer (SCLC) without lymph node involvement. In this study, the results indicated that PCI does not reduce the risk of cerebral recurrence of resected p‐T1‐2N0M0 SCLC. This is the largest sample size study focused on PCI in resected p‐T1‐2N0M0 SCLC. Future revised versions of the guidelines should address this issue.

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“…A study conducted by Vuong et al [196] found males had a higher prevalence of brain metastasis than females (p<0.001), but the frequency of brain metastasis in a study conducted by Pickren et al [131] was not different (8.8% in men and 8.7% in women). Race has not been associated with brain metastasis [131] and was not included as a covariate in the majority of studies [8,9,185,187,[189][190][191][192][193][194][195][197][198][199][200][201][202][203][204]. Breast cancer is the most common source of brain metastasis for women [5].…”

Section: Risk Factorsmentioning

confidence: 99%

Antidepressant use and risk of central nervous system metastasis

et al. 2016

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Factors Affecting the Risk of Brain Metastasis in Small Cell Lung Cancer With Surgery: Is Prophylactic Cranial Irradiation Necessary for Stage I-III Disease?

Cited by 58 publications

References 17 publications

Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation

Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation

Does surgically resected small‐cell lung cancer without lymph node involvement benefit from prophylactic cranial irradiation?

Antidepressant use and risk of central nervous system metastasis

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