Prophylactic cranial irradiation in extensive disease small cell lung cancer: An endless debate

Picardi, C; Caparroti, Francesca; Maïo, Massimo Di; Kaššák, Filip; Banna, Giuseppe Luigi; Addeo, Alfredo

doi:10.1016/j.critrevonc.2019.08.010

Cited by 9 publications

(8 citation statements)

References 45 publications

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“…To conclude, the added value of PCI for ES-SCLC patients is still being debated in the clinical community (33). This study shows that patients who are engaged in SDM on whether to undergo PCI feel sufficiently involved in the decision-making process, but a considerable portion still experience decisional conflict, particularly in understanding the benefits and risks of the treatment.…”

Section: Strengths and Limitationsmentioning

confidence: 87%

Shared decision-making for prophylactic cranial irradiation in extensive-stage small-cell lung cancer: an exploratory study

Ankolekar¹,

Ruysscher²,

Reymen³

et al. 2021

Transl Lung Cancer Res

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Background: Prophylactic cranial irradiation (PCI) offers extensive-stage small-cell lung cancer (ES-SCLC) patients a lower chance of brain metastasis and slightly longer survival but is associated with a short-term decline in quality of life due to side-effects. This tradeoff between survival and quality of life makes PCI suitable for shared decision-making (SDM), where patients and clinicians make treatment decisions together based on clinical evidence and patient preferences. Despite recent clinical practice guidelines recommending SDM for PCI in ES-SCLC, as well as the heavy disease burden, research into SDM for lung cancer has been scarce. This exploratory study presents patients' experiences of the SDM process and decisional conflict for PCI. Methods: Radiation oncologists (n=7) trained in SDM applied it in making the PCI decision with ES-SCLC patients (n=25). We measured patients' preferred level of participation (Control Preferences Scale), the level of SDM according to both groups (SDM-Q-9 and SDM-Q-Doc), and patients' decisional conflict [decisional conflict scale (DCS)].Results: Seventy-nine percent of patients preferred a collaborative role in decision-making, and median SDM scores given by patients and clinicians were 80 (IQR: 75.6-91.1) and 85.2 (IQR: 78.7-88.9) respectively, indicating satisfaction with the process. However, patients experienced considerable decisional conflict. Over 50% lacked clarity about which choice was suitable for them and were unsure what to choose. Sixty-four percent felt they did not know enough about the harms and benefits of PCI, and 60% felt unable to judge the importance of the harms/benefits in their life.Conclusions: ES-SCLC patients prefer to be involved in their treatment choice for PCI but a substantial portion experiences decisional conflict. Better information provision and values clarification may support patients in making a choice that reflects their preferences.

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Section: Strengths and Limitationsmentioning

confidence: 87%

Shared decision-making for prophylactic cranial irradiation in extensive-stage small-cell lung cancer: an exploratory study

Ankolekar¹,

Ruysscher²,

Reymen³

et al. 2021

Transl Lung Cancer Res

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“…Furthermore, NCF is associated with the generation of new neurons within this particularly sensitive area. 25 Preservation of hippocampus could further lower the risk of NCF impairment. 29 Gondi et al 30 confirmed that conformal avoidance of the hippocampal dentate gyrus using intensity-modulated radiotherapy (IMRT) is associated with a better preservation of memory and QoL.…”

Section: Discussionmentioning

confidence: 99%

“…age, sex, race) allowing to identify a sub‐population of stage II–III NSCLC patients at lower or higher risk of developing BM. It is likely that some tumor‐inherent determinants that constitute a tropism towards cranial metastasizing may be identified in the near future 25 …”

Section: Discussionmentioning

confidence: 99%

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Treatment and toxic effects of prophylactic cranial irradiation in stage II–III non–small cell lung cancer: A meta‐analysis

Wang

Wen

et al. 2020

Asia-Pac J Clncl Oncology

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Objective: To determine the role of prophylactic cranial irradiation (PCI) in non-small cell lung cancer (NSCLC) patients using meta-analysis. Methods: PubMed, Embase, the Cochrane Database of Systematic Review and the China National Knowledge Infrastructure databases were systematically searched for studies published between 1 January 1980 and 31 March 2019. Search terms included "non-small cell lung cancer," "prophylactic cranial irradiation" and "clinical trials." The research data extracted from above studies was analyzed by Review Manager 5.3 and Stata12.0 software. The outcomes included development of brain metastases (BMs), overall survival (OS), disease-free survival (DFS), BMs for different diagnoses, toxicity, quality of life (QoL). Results: Fifteen trials (nine RCTs and six non-RCTs) involving 2418 NSCLC patients met the inclusion criteria. There was a significant reduction in the risk of developing BM in patients who received PCI compared with those who did not (95% CI, 0.20-0.37; P < 0.00001). PCI significantly reduced the BM of squamous cell carcinoma (P = 0.02), but not for adenocarcinoma (P = 0.07) and other pathological types (P = 0.29). There was a significant increase in DFS for the PCI compared to the non-PCI group (P = 0.006); however, OS did not significantly differ (P = 0.15). In addition, fatigue significantly increased in the PCI group (P = 0.0002). Cognitive disturbance showed no significant difference between PCI and non-PCI groups (P = 0.06). Conclusion: This study showed that, compared with non-PCI, PCI significantly decreased the incidence of NSCLC BM and improved the DFS of patients, and reduced the BM rate from squamous cell carcinoma. However, it showed no effect on OS and the BM rate of adenocarcinoma and other pathological types of tumors. There were limited data concerning PCI-related toxicity and QoL.

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“…ES-SCLC patients rst receive chemotherapy to control the spread of metastasis. Subsequently, chest radiotherapy is recommended to control local lesions for patients who achieve CR or PR after chemotherapy [22] . Some studies found that antiangiogenic therapy can increase the local oxygen partial pressure and oxygen content of tumor tissue, inhibit the angiogenesis induced by radiotherapy, and play the role of radiotherapy sensitization [23] .…”

Section: Safetymentioning

confidence: 99%

The Efficacy And Safety of Anlotinib Combined With Platinum-Etoposide Chemotherapy As First-Line Treatment For Extensive-Stage Small Cell Lung Cancer: A Chinese Multicenter Real-World Study

Zheng

Jiang

Gao

et al. 2022

Preprint

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Background: Anlotinib, an antiangiogenic multi-target tyrosine kinase inhibitor (TKI), was approved as the third-line and above treatment for small cell lung cancer (SCLC) in China. Some small sample size clinical trials have shown the favorable efficacy of anlotinib combined with platinum-etoposide chemotherapy as the first-line treatment for extensive-stage SCLC (ES-SCLC). This research aimed to explore the real-world efficacy and safety of anlotinib combined with platinum-etoposide chemotherapy.Methods: Pathologically confirmed ES-SCLC patients receiving anlotinib plus platinum-etoposide chemotherapy as the first-line treatment were enrolled in this retrospective study. The primary endpoint of this study was progression-free survival (PFS), and secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse reactions.Results: In total, 58 patients were included in this study. The median PFS was 6.0 months [95% confidence interval (CI): 3.5-8.5], and the median OS was 10.5 months (95%CI 8.7-12.3). Thirty-four patients achieved partial response (PR), 18 patients achieved stable disease (SD), and 6 patients achieved progressive disease (PD). Respectively, the ORR and DCR were 58.6% and 89.6%. The main treatment-related adverse reactions were generally tolerated. The most common adverse reaction was myelosuppression (44.8%), followed by hypertension (41.4%), fatigue (34.5%), gastrointestinal reaction (32.7%), hand-foot syndrome (24.1%), and so on. Multivariate analysis showed that post-medication hand-foot syndrome [PFS 8.5 vs. 5.5 months, Hazards Ratio (HR)=0.23, 95%CI 0.07-0.72, P =0.012] was the independent predictor of PFS, and hypertension (OS 15.9 vs. 8.3 months, HR=0.18, 95%CI 0.05-0.58, P =0.005) was the independent predictor of OS.Conclusion: Anlotinib combined with platinum-etoposide chemotherapy as the first-line treatment for ES-SCLC appears to be effective and well-tolerated in the real-world. Patients with post-medication hypertension and hand-foot syndrome may confer superior prognosis. Further investigations are needed by prospective studies with larger sample size.

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Prophylactic cranial irradiation in extensive disease small cell lung cancer: An endless debate

Cited by 9 publications

References 45 publications

Shared decision-making for prophylactic cranial irradiation in extensive-stage small-cell lung cancer: an exploratory study

Shared decision-making for prophylactic cranial irradiation in extensive-stage small-cell lung cancer: an exploratory study

Treatment and toxic effects of prophylactic cranial irradiation in stage II–III non–small cell lung cancer: A meta‐analysis

The Efficacy And Safety of Anlotinib Combined With Platinum-Etoposide Chemotherapy As First-Line Treatment For Extensive-Stage Small Cell Lung Cancer: A Chinese Multicenter Real-World Study

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