Primary Analysis of a Phase II Randomized Trial Radiation Therapy Oncology Group (RTOG) 0212: Impact of Different Total Doses and Schedules of Prophylactic Cranial Irradiation on Chronic Neurotoxicity and Quality of Life for Patients With Limited-Disease Small-Cell Lung Cancer

Wolfson, Aaron H.; Bae, Kyounghwa; Komaki, Ritsuko; Meyers, Christina A.; Movsas, Benjamin; Péchoux, C. Le; Werner‐Wasik, Maria; Videtic, Gregory M.M.; Garces, Yolanda I.; Choy, Hak

doi:10.1016/j.ijrobp.2010.05.013

Cited by 244 publications

(230 citation statements)

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“…There is a significant discrepancy between the recommended evidence-based optimum rate of radiotherapy in lung cancer and the actual rate used in patients, since PCI is recommended for all patients (6), but not all patients receive it, which suggests that recommending PCI remains controversial among doctors and patients (11). In addition, in the present study, elderly patients were less likely to receive PCI compared with younger patients, indicating that doctors and patients were more cautious in delivering PCI to elderly patients, due to PCI potentially causing chronic neurotoxicity (12)(13)(14). Consequently, studies are required to demonstrate whether PCI is safe and effective in elderly individuals.…”

Section: Discussionmentioning

confidence: 75%

Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer

Qiu

Xiao-fang

et al. 2016

Oncology Letters

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Abstract. The benefit of prophylactic cranial irradiation (PCI) in limited-stage small-cell lung cancer (LS-SCLC) was established in a meta-analysis performed in 1999. Since then, considerable progress has been made in the diagnosis, staging and treatment of LS-SCLC, including chemotherapy and radiotherapy, which led to a longer survival time in patients. Therefore, the magnitude of the benefit of PCI should be re-evaluated. Furthermore, the optimum timing of PCI for LS-SCLC treatment has not been established and more data is required to demonstrate this. In the present retrospective study, the cases of patients that were diagnosed with LS-SCLC between March 2005 and December 2010 were reviewed. The main eligibility criteria of patients were a diagnosis of LS-SCLC and the achievement of a complete response (CR) or near CR subsequent to receiving ≥3 cycles of cisplatin-based chemotherapy, with or without advanced thoracic radiotherapy. Early and late PCI groups were separated using the median time interval between the start of primary chemotherapy and the start of PCI. In total, 80 patients were excluded from the analysis, including 9 patients that developed brain metastases, 2 during primary chemotherapy and 7 during radiotherapy. The remaining 399 patients were deemed eligible. PCI was administered to 185 patients; 92 patients were in the early PCI group and 93 were in the late PCI group. PCI significantly decreased the incidence of brain metastases [P<0.001; HR, 0.24; 95% confidence interval (CI), 0.15-0.39] and improved the overall survival time of the patients (median survival time, 21.5-38.8 months; P<0.001; HR, 0.60; 95% CI, 0.45-0.79). However, no significant difference was identified between the early and late PCI groups, either in the incidence of brain metastases (P= 0.875) or the overall survival time (P= 0.361). Multivariate analysis revealed that PCI (P=0.004) and thoracic radiotherapy (P= 0.023) were the only 2 independent favorable prognostic factors of overall survival time. The present study demonstrates that PCI may be of considerable benefit to increase the survival rate and time of patients, and early PCI is as effective as late PCI. However, the present study recommends that PCI should be offered as soon as primary chemotherapy is completed, since there is a greater risk of developing brain metastases during thoracic radiotherapy.

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Section: Discussionmentioning

confidence: 75%

Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer

Qiu

Xiao-fang

et al. 2016

Oncology Letters

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“…It must be noted that both of these studies closed prior to their targeted accrual so their findings may not be fully validated. By comparison, QOL after PCI in small cell lung cancer also showed no significant difference in QOL for the PCI-treated and observation arms (27,28).…”

Section: Discussionmentioning

confidence: 90%

The Role of Prophylactic Cranial Irradiation for Non-small Cell Lung Cancer

Precival

Landy

Poole

et al. 2018

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Abstract. Background: The use of prophylactic cranial irradiation (PCI) to treat brain metastases (BM) in non-small cell lung cancer (NSCLC) is restricted due to the potential associated toxicity and lack of survival benefit. BM can have a negative impact on neurocognitive function (NF) and quality of life (QOLProphylactic cranial irradiation (PCI) is a technique that delivers radiation therapy (RT) to the whole brain to prevent the occurrence of brain metastases (BM) in aggressive cancer types that commonly metastasise to the brain (1). The rationale behind PCI is to eliminate undetectable micrometastases before they become clinically apparent (1).According to the American Cancer Society, about 85-95% of all lung cancer cases are non-small cell lung cancer (NSCLC) (2). The brain is the first site of metastases for up to 30% of these patients (3), with 60% of BM occurring in the first 6 months (4). With modern advances in the management of NSCLC, the risk of developing BM increases as survival is prolonged (5). The reported incidence of BM from NSCLC ranges from 17% to 54%, with younger patients, those with locally advanced-stage disease, adenocarcinoma and large cell types at the higher end of this range of incidence (4, 6-9). BM are associated with high morbidity, poor prognosis (10) and neurocognitive and quality of life (QOL) deficits (10-12).Patients with small cell lung cancer derive an overall (OS) and BM-free survival benefit from PCI (13). PCI for patients with NSCLC is not widely used due to the lack of established evidence for OS benefit and the potential for neurological toxicity post RT. PCI for NSCLC may not have an impact on OS or disease-free survival (DFS) but it has been shown to reduce the incidence of BM (11,(14)(15)(16)(17)(18)(19), therefore it is a matter of debate if these patients benefit from PCI.Late cognitive toxicities are suggested to be associated with PCI and these may be a factor in the prescribing of this treatment. The Radiation Therapy Oncology Group trial (RTOG)-0214 reported a significant decline in memory at 1 year with PCI use (20). Neurocognitive function (NF) decline may occur as a direct result of vascular injury, demyelination or radionecrosis (20).This review aimed to investigate published literature on the use of PCI in patients with NSCLC to assess the impact of PCI on disease-specific outcomes and report the effects of PCI on NF and QOL outcomes. Materials and MethodsTo ensure all appropriate studies were included in this review, a systematic approach was used for searching and selecting relevant publications. As the technique for treating PCI has remained relatively unchanged over the years,

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“…The risk for neurocognitive decline after PCI has been reported as 30-60% after 1 year [85,[89][90][91], depending on the measure of neurocognitive impairment. Patients at higher risk for neurocognitive deterioration (e.g.…”

Section: Prophylactic Cranial Irradiationmentioning

confidence: 99%