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

Eze, Chukwuka; Roengvoraphoj, Olarn; Niyazi, Maximilian; Hildebrandt, Guido; Fietkau, Rainer; Belka, Claus; Manapov, Farkhad

doi:10.1016/j.cllc.2016.11.005

Cited by 25 publications

(20 citation statements)

References 67 publications

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“…Other research reports that lung cancer is more prone to bone metastases because of the microenvironment of the bone that is affected by the bone matrix, the immune system cells, and the same cancer cells (Roato, 2014). At the time of the initial diagnosis, approximately 20% of patients with SCLC have detectable brain metastases (Eze et al, 2017), which is roughly in line with our findings. According to the most recent Eighth Edition of the Tumor, Node, and Metastasis (TNM) Classification of Lung Cancer, a larger tumor indicates a higher T stage (Rami-Porta et al, 2017).…”

Section: Discussionsupporting

confidence: 91%

Different distant metastasis patterns based on tumor size could be found in extensive-stage small cell lung cancer patients: a large, population-based SEER study

Liu

et al. 2019

PeerJ

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Background Small-cell lung cancer (SCLC) is a malignant cancer with the ability to metastasize quickly. The relationship between tumor size and the distant metastasis patterns of Extensive-Stage Small Cell Lung Cancer (ES-SCLC) has not been reported.ObjectivesThe aim of this study was to determine the different distant metastasis patterns as they related to tumor size in ES-SCLC.Patients and MethodsWe used Surveillance, Epidemiology, and End Results (SEER) population-based data collected from 2010 through 2013 to identify 11058 ES-SCLC patients with definite evidence of distant metastases. Multivariate logistic regression analysis was used to demonstrate the association between tumor size and distant metastasis patterns including bone, liver, brain, and lung metastases. Age, race, sex, and N stage were also selected in the logistic regression model.ResultsSubtle differences in metastasis patterns were found among patients based on different tumor sizes. Patients with tumors 3–7 cm have a higher risk of bone metastasis compared with those that have tumors ≤3 cm (OR 1.165, 95% CI [1.055–1.287], P = 0.003) and patients with tumors ≥7 cm have a higher risk of lung metastasis (OR 1.183, 95% CI [1.039–1.347], P = 0.011). In addition, patients with tumors ≥7 cm had a lower risk of brain metastasis and liver metastasis than patients with tumors ≤3 cm (OR 0.799, 95% CI [0.709–0.901], P < 0.001; OR 0.747, 95% CI [0.672–0.830], P < 0.001). Interestingly, there was no correlation between a larger tumor and a higher risk of metastasis. However, the tumor metastasis pattern did have some correlation with age, gender, race and N-status.ConclusionThe pattern of distant metastasis of ES-SCLC is related to the tumor size and the tumor size is indicative of the metastatic site. Larger tumor sizes did not correlate with a higher risk of distant metastasis, but the size is related to the pattern of distant metastasis. The study of different distant metastasis patterns based on tumor size and other clinical features (e.g., age, race, sex, and N stage) in ES-SCLC is clinically valuable.

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Section: Discussionsupporting

confidence: 91%

Different distant metastasis patterns based on tumor size could be found in extensive-stage small cell lung cancer patients: a large, population-based SEER study

Liu

et al. 2019

PeerJ

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“…However, our study showed different results. Eze et al [ 17 ] described a prognostic role of PCI in LS-SCLC and described a similarly significant magnitude of this benefit regardless of brain MRI after initial treatment, and this supported our results. There may be limits to imaging-guided evaluation for these conditions.…”

Section: Discussionsupporting

confidence: 91%

Impact of prophylactic cranial irradiation on pattern of brain metastases as a first recurrence site for limited-disease small-cell lung cancer

Nakamura

Onozawa

Motegi

et al. 2018

Journal of Radiation Research

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This study sought to evaluate the impact of prophylactic cranial irradiation (PCI) on the pattern of brain recurrence after radical treatment in patients with limited-disease small-cell lung cancer (LD-SCLC). Patients treated with radiotherapy and chemotherapy between January 2006 and December 2014 at a single institution were retrospectively examined. Radiotherapy was performed using accelerated hyperfractionated radiotherapy (twice daily, 45 Gy in 30 fractions) or conventional fractionated radiotherapy (once daily, 50 Gy in 25 fractions). The chemotherapy regimen consisted of intravenous platinum–etoposide. A total of 162 patients were included and the median follow-up duration was 38 months. Ninety-three patients underwent PCI, and the 3-year overall survival (OS) rates were 14% among patients without PCI and 41% among those with PCI (P < 0.001). The frequency of brain metastases as a first recurrence site (BMFR) was significantly lower among patients who underwent PCI, compared with those who did not (P = 0.002). The median time to the l of BMFR was significantly shorter among patients without PCI than among those with PCI (P = 0.012). In addition, 68% of the BMFR patients who did not undergo PCI exhibited five or more lesions, while only 12% of BMFR patients who did undergo PCI exhibited five or more lesions (P < 0.001). PCI had a significant positive impact on patient prognosis after radical treatment for LD-SCLC, and the difference in the number of, and time to the appearance of, BMFR between patients treated with PCI and those treated without PCI might affect the clinical outcomes.

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“…Another retrospective study showed that PCI strongly correlated with prolonged OS and BMFS for patients without BM on contrast-enhanced MRI. 25 In our study, for patients showing no BM on MRI after definitive CRT, PCI conferred less BM incidence and better OS. However, a significant portion of patients may choose not to undergo PCI when presented with the potential neurologic toxicities.…”

Section: Discussionmentioning

confidence: 48%

Prophylactic cranial irradiation confers favourable prognosis for patients with limited‐stage small cell lung cancer in the era of MRI: A propensity score‐matched analysis

Ding

Yang

et al. 2021

J Med Imag Rad Onc

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Introduction: Prophylactic cranial irradiation (PCI) is recommended for patients with limited-stage small cell lung cancer (LS-SCLC) who achieve good response after chemoradiotherapy. But PCI is neurotoxic. Magnetic resonance imaging (MRI) is the standard tool for evaluating brain metastasis (BM). This study was to retrospectively analyse the necessity of PCI in the era of MRI in LS-SCLC. Methods: From July 2013 to June 2017, 190 patients with LS-SCLC who were treated with definitive chemoradiotherapy were included and analysed in this study. They were divided into the PCI group and non-PCI group. Propensity score matching (PSM) analysis was used to balance the variable differences. The Kaplan-Meier method was applied to estimate survival with log-rank test to ascertain significance between different groups. Results: Seventy-seven patients (40.5%) received PCI after chemoradiotherapy. After adjustment for propensity scores, 69 pairs of patients were matched between two groups. After PSM, the 1-year and 3-year OS rates were 96.9% and 48.5% in PCI group versus 89.9% and 25.0% in non-PCI group (HR: 0.419, 95% CI: 0.251-0.701, P = 0.001). The 1-year and 3-year BMFS in PCI group were 96.8% and 67.5% versus 62.3% and 37.9% in non-PCI group (HR: 0.247, 95% CI: 0.132-0.460, P < 0.001). Conclusion:For patients showing no BM on MRI after definitive CRT, PCI confers less BM and better OS in LS-SCLC.

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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

Abstract: In real-life patients comprehensively staged with cranial magnetic resonance imaging, treatment response and PCI strongly correlated with prolonged OS, TTP, and BMFS.

Cited by 25 publications

References 67 publications

Different distant metastasis patterns based on tumor size could be found in extensive-stage small cell lung cancer patients: a large, population-based SEER study

Different distant metastasis patterns based on tumor size could be found in extensive-stage small cell lung cancer patients: a large, population-based SEER study

Impact of prophylactic cranial irradiation on pattern of brain metastases as a first recurrence site for limited-disease small-cell lung cancer

Prophylactic cranial irradiation confers favourable prognosis for patients with limited‐stage small cell lung cancer in the era of MRI: A propensity score‐matched analysis

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