Prophylactic cranial irradiation for lung cancer patients at high risk for development of cerebral metastasis: Results of a prospective randomized trial conducted by the radiation therapy oncology group

Russell, Anthony H.; Pajak, Thomas; Selim, H.; Paradelo, Jorge C.; Murray, Kevin; Bansal, Pooja; Cooper, Jay; Silverman, S; Clement, J.A.

doi:10.1016/0360-3016(91)90681-s

Cited by 158 publications

(119 citation statements)

References 27 publications

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“…Although randomized studies have failed to establish a survival benefit for PCI, subset analysis was not performed and it remains possible that selected patients, particularly those without evidence of disease at the primary or other extracranial sites, may significantly benefit from the prevention of brain metastasis. [10][11][12][13] Likewise, some studies have suggested that early detection of brain metastasis from NSCLC and prompt treatment with SRS can significantly improve survival, particularly among those without evidence of extracranial disease. 14,15 Whereas the optimal local-regional treatment approach for locally advanced NSCLC is uncertain, the integration of surgery as a component of multimodality therapy may enable the identification of a subset of patients, those with a pathological complete response (pCR) to neoadjuvant chemotherapy or chemoradiotherapy, who may be at high risk for the subsequent development of brain metastases.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] However, these results have been criticized because of patient heterogeneity and for possible imbalances in stratification according to established prognostic variables. It is unknown to what extent the development of local-regional failure or extracranial disease progression may have obscured any potential benefits that PCI may have conferred.…”

Section: Discussionmentioning

confidence: 99%

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Risk of cerebral metastases and neurological death after pathological complete response to neoadjuvant therapy for locally advanced nonsmall‐cell lung cancer

Chen

Jahan

Jablons

et al. 2007

Cancer

127

100

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BACKGROUND. The incidence and pattern of brain metastases was analyzed among patients who achieved a pathological complete response (pCR) after neoadjuvant chemotherapy or chemoradiotherapy for locally advanced nonsmall‐cell lung cancer (NSCLC). METHODS. Between 1990 and 2004, 211 patients were treated with neoadjuvant therapy before surgical resection for stage III NSCLC. The clinical course of 51 patients who demonstrated a pCR were reviewed. The neoadjuvant regimen consisted of either chemotherapy (29 patients) or chemoradiotherapy (22 patients). Histology was 45% adenocarcinoma, 41% squamous cell, and 14% large cell carcinoma. No patient received prophylactic cranial irradiation (PCI). RESULTS. Overall survival at 1, 3, and 5 years was 82%, 63%, and 42%, respectively. The most common site of initial recurrence was the brain. Twenty‐two (43%) patients developed brain metastasis as the site of first failure, which represented 71% of all isolated recurrences. Ultimately, 28 (55%) patients developed brain metastases at some point during their clinical course. The 5‐year estimates of brain metastasis‐free survival for patients with squamous and nonsquamous cancers were 57% and 34%, respectively (P = .02). Median survival from the time of brain metastasis was 10 and 5 months for those with isolated and nonisolated recurrences, respectively. CONCLUSION. Patients with a pCR after multimodality therapy for locally advanced NSCLC are at excessively high risk for the subsequent development of brain metastases. Implications for management strategies including PCI and stereotactic radiosurgery (SRS) are discussed. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of cerebral metastases and neurological death after pathological complete response to neoadjuvant therapy for locally advanced nonsmall‐cell lung cancer

Chen

Jahan

Jablons

et al. 2007

Cancer

127

100

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“…56 Only patients with adenocarcinoma or large cell histology were eligible. The incidence of brain metastases was not statistically different with PCI (9% vs 19%, P ¼ .10), and there was no difference in overall survival.…”

Section: Biological Predictorsmentioning

confidence: 99%

Factors associated with the development of brain metastases

Hubbs

Boyd

Hollis

et al. 2010

Cancer

120

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BACKGROUND The risk of developing brain metastases after definitive treatment of locally advanced nonsmall cell lung cancer (NSCLC) is approximately 30%-50%. The risk for patients with early stage disease is less defined. The authors sought to investigate this further and to study potential risk factors. METHODS The records of all patients who underwent surgery for T1-T2 N0-N1 NSCLC at Duke University between the years 1995 and 2005 were reviewed. The cumulative incidence of brain metastases and distant metastases was estimated by using the Kaplan-Meier method. A multivariate analysis assessed factors associated with the development of brain metastases. RESULTS Of 975 consecutive patients, 85% were stage I, and 15% were stage II. Adjuvant chemotherapy was given to 7%. The 5-year actuarial risk of developing brain metastases and distant metastases was 10%(95% confidence interval [CI], 8-13) and 34%(95% CI, 30-39), respectively. Of patients developing brain metastases, the brain was the sole site of failure in 43%. On multivariate analysis, younger age (hazard ratio [HR], 1.03 per year), larger tumor size (HR, 1.26 per cm), lymphovascular space invasion (HR, 1.87), and hilar lymph node involvement (HR, 1.18) were associated with an increased risk of developing brain metastases. CONCLUSIONS In this large series of patients treated surgically for early stage NSCLC, the 5-year actuarial risk of developing brain metastases was 10%. A better understanding of predictive factors and biological susceptibility is needed to identify the subset of patients with early stage NSCLC who are at particularly high risk. Cancer 2010;116:5038-46.

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“…[18] Six randomised controlled trials have evaluated the role of PCI in LA-NSCLC, with five studies demonstrating a statistically significant reduction in the incidence of BM with PCI, but no survival advantage. [10,[19][20][21][22][23] The most recent of these studies was underpowered for a survival endpoint. [10] It is not clear whether patient refusal was the reason why target accrual was not met.…”

Section: Discussionmentioning

confidence: 99%

Patient preferences regarding prophylactic cranial irradiation: A discrete choice experiment

Lehman

Gorayski

Watson

et al. 2016

Radiotherapy and Oncology

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Prophylactic cranial irradiation for lung cancer patients at high risk for development of cerebral metastasis: Results of a prospective randomized trial conducted by the radiation therapy oncology group

Cited by 158 publications

References 27 publications

Risk of cerebral metastases and neurological death after pathological complete response to neoadjuvant therapy for locally advanced nonsmall‐cell lung cancer

Risk of cerebral metastases and neurological death after pathological complete response to neoadjuvant therapy for locally advanced nonsmall‐cell lung cancer

Factors associated with the development of brain metastases

Patient preferences regarding prophylactic cranial irradiation: A discrete choice experiment

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