Prophylactic Cranial Irradiation in Extensive Disease Small-Cell Lung Cancer: Short-Term Health-Related Quality of Life and Patient Reported Symptoms—Results of an International Phase III Randomized Controlled Trial by the EORTC Radiation Oncology and Lung Cancer Groups

Slotman, Ben J.; Mauer, Murielle; Bottomley, Andrew; Faivre-Finn, Corinne; Kramer, G.; Rankin, Elaine M.; Snee, M.; Hatton, Matthew; Postmus, Pieter E.; Collette, Laurence; Senan, Suresh

doi:10.1200/jco.2008.17.0746

Cited by 224 publications

(183 citation statements)

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“…Therefore, patients with complete response to chemotherapy are offered prophylactic cranial irradiation. 24,25 Similarly, patients with SCCB show a risk for the development of brain metastases. Siefker-Radtke et al reported up to 26.7% brain metastases in patients with SCCB.…”

Section: Discussionmentioning

confidence: 99%

Local control rate and prognosis after sequential chemoradiation for small cell carcinoma of the bladder

et al. 2012

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Abbreviations & Acronyms AWD = alive with disease AWOD = alive without disease BCG = bacillus Calmette-Guérin CaE = carboplatin/etoposide CDE = cyclophosphamide/ doxorubicine/etoposide CE = cisplatin/etoposide CIS = carcinoma in situ CR = complete response; CSS = cancer-specific survival CT = computed tomography DOD = died of disease DOOD = died of other disease; EBRT = external beam radiotherapy ED = extensive disease ED-SCCB = extensive disease small cell carcinoma of the bladder GC = gemcitabin/cisplatin IQR = interquartile range LD = limited disease LD-SCCB = limited disease small cell carcinoma of the bladder MVAC = methotrexate// vinblastine/doxorubicine/cisplatin OS = overall survival PR = partial response SCC = small cell carcinoma SCCB = small cell carcinoma of the bladder SCLC = small cell lung carcinoma SD = stable disease SEER = Surveillance, Epidemiology and End Results TNM = tumor-nodes-metastasis TUR-BT = transurethral resection of the bladder tumor UCC = urothelial cell carcinoma Objectives: To assess the long-term outcome and the risk for local recurrence of patients with small cell carcinoma of the bladder (SCCB) treated with neoadjuvant chemotherapy followed by external beam radiotherapy (sequential chemoradiation). Methods: All consecutive patients with primary small cell carcinoma of the bladder (n = 66), treated in our institution between 1993 and 2011 were retrospectively evaluated from an institutional database. Only patients with limited disease (Tx-4N0-1M0) small cell carcinoma of the bladder treated with sequential chemoradiation (n = 27) were included in this study. Recurrence rates, overall survival and cancer-specific survival were analyzed using the Kaplan-Meier method. Results: Median time to recurrence was 20 months, median overall survival 26 months, 5-year overall survival 22.2%, median cancer-specific survival 47 months and 5-year cancer-specific survival 39.6%. For complete responders after neoadjuvant chemotherapy (n = 19), median cancer-specific survival was 52 months with a 5-year cancer-specific survival 45.9% versus a median cancer-specific survival of 22 months and 5-year cancer-specific survival 0.0% for incomplete responders (n = 8; P = 0.034). Eight patients (29.6%) underwent transurethral resections (TUR-BT) for local recurrences in the bladder. At the end of follow up, four patients had undergone cystectomy for recurrence of disease resulting in a bladder-preservation rate of 85.2%. Median time to local recurrence was 29 months and median time to distant recurrence was 10 months. Conclusions: Sequential chemoradiation for limited disease small cell carcinoma of the bladder results in a reasonable outcome with a high bladder preservation rate. Response to neoadjuvant chemotherapy represents a significant prognostic factor in this patient population.

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Section: Discussionmentioning

confidence: 99%

Local control rate and prognosis after sequential chemoradiation for small cell carcinoma of the bladder

et al. 2012

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“…Interestingly, the main reason for patient refusal to participate in the GawkowskaSuwińska et al study was fear of alopecia. A study of PCI for small cell lung cancer commented that decline in QOL was specifically linked to hair-loss and fatigue (32); therefore if PCI is implemented consideration of hair-loss and fatigue management should be areas of focus. Other late toxicities recorded include mild headache or slight lethargy (22.2%), moderate headache or great lethargy (11.1%) and severe headaches (2.5%) (18).…”

Section: Discussionmentioning

confidence: 99%

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 QLQ-BN20 has been used to assess QOL in lung cancer patients undergoing prophylactic cranial irradiation [23]. Conducting content validation aims to demonstrate the subjective validity of the questionnaire, as primary brain tumour patients may present with slightly different issues than brain metastases patients.…”

Section: Discussionmentioning

confidence: 99%

Content validation of the EORTC QLQ-BN20+2 with patients and health care professionals to assess quality of life in brain metastases

et al. 2012

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Objective The validated EORTC quality of life (QOL) questionnaire QLQ-BN20 is a cancer subtype-specific supplement to the QLQ-C30 general QOL questionnaire for patients with primary brain neoplasms. The QLQ-C15-PAL core palliative questionnaire is an abbreviated version of the QLQ-C30 designed to decrease patient burden. We conducted content validation of the QLQ-BN20+2 for patients with brain metastases. Methods and materials Patients undergoing treatment for brain metastases, along with health care professionals (HCPs) completed the QLQ-C15-PAL and QLQ-BN20+2 questionnaires. A structured interview followed to assess for any difficulties with the QLQ-BN20+2, irrelevant items, and whether additional pertinent items should be included. Results Seventy-four patients and 71 HCPs participated. The majority of patients (84 %) were treated with whole-brain radiotherapy only. Over 50 % of patients felt that seizures, hair loss and trouble controlling bladder were not related to brain metastases. Questions regarding uncertainty about the future were the most difficult, although still a small proportion (12-16 %). All items were endorsed by over 50 % of HCPs as 'quite' or 'very' relevant to brain metastases patients, with two exceptions: 15 and 12 % of HCPs rated pruritis and future uncertainty as irrelevant, respectively. Conclusion We report the first content validation of the QLQ-BN20+2 and QLQ-C15-PAL QOL questionnaires for patients undergoing treatment for brain metastases, demonstrating feasibility and relevance. These questionnaires should be used together as universal QOL assessment tools in this setting.

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Prophylactic Cranial Irradiation in Extensive Disease Small-Cell Lung Cancer: Short-Term Health-Related Quality of Life and Patient Reported Symptoms—Results of an International Phase III Randomized Controlled Trial by the EORTC Radiation Oncology and Lung Cancer Groups

Cited by 224 publications

References 17 publications

Local control rate and prognosis after sequential chemoradiation for small cell carcinoma of the bladder

Local control rate and prognosis after sequential chemoradiation for small cell carcinoma of the bladder

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

Content validation of the EORTC QLQ-BN20+2 with patients and health care professionals to assess quality of life in brain metastases

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