Rates of Overall Survival and Intracranial Control in the Magnetic Resonance Imaging Era for Patients With Limited-Stage Small Cell Lung Cancer With and Without Prophylactic Cranial Irradiation

Abstract

IMPORTANCE Historical data suggest that there is an overall survival benefit associated with prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC). However, as the fidelity of magnetic resonance imaging (MRI) of the brain continues to improve, this idea is now being questioned, with recent research showing no survival benefit associated with PCI in extensive-stage SCLC; however, the role for PCI is not clear in patients with limited-stage SCLC (LS-SCLC).OBJECTIVE To report the overall survival and rates of intracranial control for patients with LS-SCLC, all staged with MRI, who either did or did not undergo PCI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 297 patients with LS-SCLC at alarge US academic cancer center. Patients were treated with thoracic radiation; 205 also underwent PCI and 92 did not. All patients underwent at least baseline MRI, with restaging brain MRI and/or computed tomography; they did not have disease progression after thoracic radiation treatment. A propensity score-matching analysis was undertaken in an attempt to adjust for potential bias. Of the 297 patients who met the inclusion criteria, the propensity score was calculated for 295 patients, using patient, tumor, and treatment characteristics. Data were analyzed in October 2019. INTERVENTION Prophylactic cranial irradiation in patients with LS-SCLC. MAIN OUTCOMES AND MEASURESThe rate of overall survival and intracranial control. RESULTSOf the 297 patients, 162 (54.5%) were men. The median age was 62.2 years (range, 27.0-85.0 years) for patients who underwent PCI and 68.6 years (range, 40.0-86.0 years) for those who did not undergo PCI. The 3-year cumulative incidence rate of brain metastases was higher in the no-PCI group vs the PCI group, when counting death as a competing risk, but the difference was not statistically significant (20.40% [95% CI, 12.45%-29.67%] vs 11.20% [95% CI, 5.40%-19.20%]; P = .10). The use of PCI was not associated with a difference in overall survival between the patient groups (hazard ratio, 0.844; 95% CI, 0.604-1.180; P = .32). CONCLUSIONS AND RELEVANCEThese findings suggest that patients with LS-SCLC staged with MRI who undergo PCI after thoracic radiation treatment were not associated with a decreased risk of developing new brain metastases compared with patients who do not undergo PCI. The use of PCI was not associated with an overall survival benefit for such patients. 17. Ozawa Y, Omae M, Fujii M, et al. Management of brain metastasis with magnetic resonance imaging and stereotactic irradiation attenuated benefits of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer. BMC Cancer. 2015;15(587):589.

Differentiation of brain metastases from small and non-small lung cancers using apparent diffusion coefficient (ADC) maps

“…Although brain metastases are improbable in early stage NSCLC without central neurologic symptoms [ 13 ], the risk of brain metastasis, especially in SCLC is omnipresent [ 14 ]. Large studies show bad survival rates for patients with limited [ 15 ] and extended disease [ 16 – 18 ].…”

Kleinzelliges Lungenkarzinom

“…Aktuelle, prospektive Studiendaten, die auch die konsequent ein MRT als Entscheidungskriterien verwenden, liegen nicht vor. Retrospektive Analysen aus einzelnen Zentren deuten einen begrenzten klinischen Nutzen für eine prophylaktische Ganzhirnbestrahlung bei negativem Schädel-MRT an [8]. Nach der aktuellen Leitlinie sollte dennoch allen Patienten mit Remission nach Abschluss der Radiochemotherapie, die sich in gutem sonstigem Gesundheitszustand befinden und bei denen in einer aktuellen MRT des Schädels eine Hirnmetastasierung ausgeschlossen wurde, eine prophylaktische Schädelbestrahlung angeboten werden.…”

Prophylactic cranial irradiation in patients with small cell lung cancer in The Netherlands: A population-based study

“…Among these inconclusive studies, most studies did not perform routine brain-MRI at baseline to exclude BM. In fact, in the LS-SCLC studies that did report baseline MRI in (all or some) patients, 4 out of 6 studies found no significant improvement in BM incidence after PCI [18] , [25] , [26] , [27] and 3 out of 4 studies observed no OS benefit [27] , [28] , [29] .…”