Primary tumor response to chemoradiotherapy in limited-disease small-cell lung cancer correlates with duration of brain-metastasis free survival

Abstract

The brain represents a crucial site of failure in limited-disease (LD) small-cell lung cancer (SCLC). However, no data about correlation between response of primary tumor to chemoradiotherapy (CRT) and brain metastases (BM)--free survival time in LD SCLC are available. A total of 125 LD SCLC patients with initial performance score of WHO 2-3 were successfully treated with CRT. Prophylactic cranial irradiation (PCI) was applied after complete response. Cranial MRI was performed in patients at initial diagnosis, in complete responders before PCI, and by individual symptoms. A total of 30 patients (24 %) developed BM after CRT; 5 of them (17 %) developed BMs after PCI. Ten patients (33 %) show BM after complete, 5 (17 %) after partial and 15 (50 %) after non-response of primary tumor (p < 0.0001) to applied CRT. BM-free survival time for the entire cohort was 298 days (95 CI: 218-377): 567 days (95 CI: 322-811) in complete, 298 days (95 CI: 244-351) in partial and 252 days (95 CI: 217-286) in non-responders (p < 0.0001). PCI prolonged BM-free survival time in complete responders: 640 days (95 CI: 483-796) with PCI versus 482 days (95CI: 111-926) without PCI (p = 0.047) versus 273 days (95 CI: 243-302) for partial and non-responders. The duration of BM-free survival was shown to correlate with long-term outcome in the Pearson and Spearman's tests (p < 0.0001). The response of primary tumor to CRT strongly affects duration of BM-free survival in LD SCLC and should be considered by planning of the timing of PCI.

Treatment Response and Prophylactic Cranial Irradiation Are Prognostic Factors in a Real-life Limited-disease Small-cell Lung Cancer Patient Cohort Comprehensively Staged With Cranial Magnetic Resonance Imaging

“…Moreover, the response of the primary tumour to CRT correlated with the duration of BM-free survival in LS-SCLC. 65 The second publication sought to characterise the role of PCI in an actual heterogeneous LS-SCLC cohort. Based on a previous publication by Manapov et al published in 2008 which detected a significant incidence of BM in LS-SCLC patients who initially showed no signs of BM prior to primary treatment but showed evidence of BM on repeat MRI before PCI.…”

Evaluation of the role of remission status in a heterogeneous limited disease small-cell lung cancer patient cohort treated with definitive chemoradiotherapy

“…A 1997 published trial on the timing of TRT has already described significantly higher complete remission rates associated with better long-term outcome in the early versus late irradiation group [9]. Correlation between remission status after CRT and brain-metastasis free survival in LD SCLC has also been previously documented [10]. …”

Effects of the regulation of polysialyltransferase ST8SiaII on the invasiveness and metastasis of small cell lung cancer cells

“…Although SCLC is sensitive to chemotherapy and radiotherapy, most patients show only a partial response (PR), and few achieve complete remission (CR). In addition, the SCLC patients who do reach a PR or CR are known to be prone to relapse and metastasis within a short period (3,4). Prevention of the invasiveness and metastasis of SCLC has become a bottleneck in the prognosis of SCLC patients and an urgent clinical problem (5).…”