Prophylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer: Do all patients benefit?

Abstract

Purpose Prophylactic cranial irradiation (PCI) can improve overall survival (OS) and suppress brain metastases (BM) in patients with limited-stage small cell lung cancer (LS-SCLC) after complete response to primary therapy. However, PCI can be toxic. We sought to identify characteristics of patients who may not benefit from PCI. Methods We identified 658 patients who received chemoradiotherapy at MD Anderson in 1986–2012; 364 received PCI and 294 did not. Median follow-up time was 21.2 months (range 1.2–240.8 months). Cox proportional hazards regression, competing-risk regression, and Kaplan-Meier analyses were used to identify factors influencing OS and BM. Results PCI reduced risks of death [HR 0.73, 95% CI 0.61–0.88, P=0.001] and BM [HR 0.54, 95% CI 0.39–0.76, P<0.001]. Having tumors ≥5 cm increased the risk of BM [HR 1.77, 95% CI 1.22–2.55, P=0.002] but not death [HR 1.16, 95% CI 0.96–1.40, P=0.114]. Among patients ≥70 years with ≥5-cm tumors, PCI did not improve OS [2-year rates 39.4% vs 40.9%, P=0.739]. Conclusions PCI remains standard therapy after complete response to chemoradiotherapy for LS-SCLC. However, older patients may be at risk from comorbidity or extracranial disease. Further work is warranted to identify patients who may not benefit from PCI.

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

“…A recent report from MD Anderson Cancer Center reported that patients with larger primary tumors (≥5cm) had higher risk of brain metastasis, which is broadly consistent with our findings; however, they did not analyze patients according to TNM stage group. [16]…”

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

“…59,60 Also, a large cohort study regarding therapeutic whole brain irradiation reported significant toxicity such as neurocognitive dysfunction with memory loss in patients older than 70 years. 61 In this context, elderly patients are the focus of research to reduce treatment-related toxicity of cranial irradiation and improve prognosis.…”

The Factors Influencing the Utilization of Prophylactic Cranial Irradiation in Patients With Limited-Stage Small Cell Lung Cancer

“…5 Another study by Farooqi et al examined 658 patients with LS-SCLC who received chemotherapy and RT. 25 The authors reported that 55% of these patients received PCI, which improved OS and brain metastasis-free survival. However, unlike our study and the one by Giuliani et al, the non-PCI group in the Farooq et al study included patients with no response or with early disease progression after local therapy, thereby including unfavorable patients in the analysis.…”