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Long-term outcomes and failure patterns of prophylactic cranial irradiation in limited-stage small cell lung cancer patients managed with modern chemoradiotherapy and diagnostic methods
Liu Xuan, Zhou Zongmei, Xiao Zefen, Feng Qinfu, Chen Dongfu, Lyu Jima, Liang Jun, Bi Nan, Wang Xin, Deng Lei, Zhang Tao, Wang Wenqing, Wang Xiaozhen, Hui Zhouguang, Wang Lyuhua
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
AbstractObjective To evaluate the clinical efficacy and failure patterns of prophylactic cranial irradiation (PCI) in patients with limited-stage small cell lung cancer (LS-SCLC) on the basis of modern chemoradiotherapy and diagnostic techniques. Methods In this retrospective study, clinical data of 201 LS-SCLC patients treated with chemotherapy (EP/CE regimens,≥4 cycles) and intensity-modulated radiotherapy (IMRT) in Cancer Hospital of Chinese Academy of Medical Sciences from 2006 to 2014 were reviewed. All patients were primarily managed with concurrent or sequential chemoradiotherapy and achieved complete response (CR) or partial response (PR). Ninety percent of patients were revaluated for brain metastasis (BM) by MRI and 10% by CT scan. Long-term survival and failure patterns were compared between the PCI (n=91) and non-PCI groups (n=110). Results The median follow-up time was 77.3 months (95%CI 73.0-81.5 months). The median overall survival (OS), 2-and 5-year OS rates were 58.5 months, 72.5% and 47.7% in the PCI group, and 34.5 months, 61.7% and 35.8% in the non-PCI group (P=0.075). The median progression-free survival (PFS), 2-and 5-year PFS rate were 22.0 months,48.0% and 43.4% in the PCI group, significantly higher than 13.9 months, 34.4% and 26.7% in the non-PCI group (P=0.002). The 2- and 5-year cumulative incidence of BM were 6.6% and 12.2% in the PCI group, and 30.0% , 31.0% in the non-PCI group (P=0.001). The median time and rate of BM as an isolated first site of relapse were 11.9 months and 4.4% in the PCI group, and 8.7 months and 25.5% in the non-PCI group (P＜0.001). Multivariate analysis showed that response after chemoradiotherapy (P＜0.001) and PCI (P=0.033) were the independent prognostic factors for PFS. Stratified analysis demonstrated that PCI significantly improved the 5-year PFS in patients who achieved CR (72.7% vs. 48.0%, P=0.013), while it did not improve the 5-year PFS in patients who obtained PR (26.1% vs. 20.2%, P=0.213).Conclusion In the new era of standard chemoradiotherapy and more accurate diagnostic methods for BM, PCI was associated with improved PFS and lower incidence of BM in LS-SCLC patients.
Liu Xuan,Zhou Zongmei,Xiao Zefen et al. Long-term outcomes and failure patterns of prophylactic cranial irradiation in limited-stage small cell lung cancer patients managed with modern chemoradiotherapy and diagnostic methods[J]. Chinese Journal of Radiation Oncology, 2021, 30(2): 114-119.
Liu Xuan,Zhou Zongmei,Xiao Zefen et al. Long-term outcomes and failure patterns of prophylactic cranial irradiation in limited-stage small cell lung cancer patients managed with modern chemoradiotherapy and diagnostic methods[J]. Chinese Journal of Radiation Oncology, 2021, 30(2): 114-119.
[1] van Meerbeeck JP, Fennell DA, De Ruysscher DK. Small-cell lung cancer[J]. Lancet, 2011, 378(9804):1741-1755. DOI:10.1016/S0140-6736(11)60165-7. [2] Sakaguchi M, Maebayashi T, Aizawa T, et al. Treatment outcomes of patients with small cell lung cancer without prophylactic cranial irradiation[J]. J Thorac Dis, 2016, 8(9):2571-2579. DOI:10.21037/jtd.2016.08.73. [3] Blanchard P, Le Pechoux C. Prophylactic cranial irradiation in lung cancer[J]. Curr Opin Oncol, 2010, 22(2):94-101. DOI:10.1097/CCO.0b013e32833500ef. [4] Auperin A, Arriagada R, Pignon JP, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group[J]. N Engl J Med, 1999, 341(7):476-484. DOI:10.1056/NEJM199908123410703. [5] Arriagada R, Le Chevalier T, Riviere A, et al. Patterns of failure after prophylactic cranial irradiation in small-cell lung cancer:analysis of 505 randomized patients[J]. Ann Oncol, 2002, 13(5):748-754. DOI:10.1093/annonc/mdf123. [6] Faivre-Finn C, Snee M, Ashcroft L, et al. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT):an open-label, phase 3, randomised, superiority trial[J]. Lancet Oncol, 2017, 18(8):1116-1125. DOI:10.1016/S1470-2045(17)30318-2. [7] Levy A, Le Pechoux C, Mistry H, et al. Prophylactic cranial irradiation for limited-stage small-cell lung cancer patients:secondary findings from the prospective randomized phase 3 CONVERT trial[J]. J Thorac Oncol, 2019, 14(2):294-297. DOI:10.1016/j.jtho.2018.09.019. [8] Hochstenbag MM, Twijnstra A, Wilmink JT, et al. Asymptomatic brain metastases (BM) in small cell lung cancer (SCLC):MR-imaging is useful at initial diagnosis[J]. J Neurooncol, 2000, 48(3):243-248. [9] Seute T, Leffers P, Wilmink JT, et al. Response of asymptomatic brain metastases from small-cell lung cancer to systemic first-line chemotherapy[J]. J Clin Oncol, 2006, 24(13):2079-2083. DOI:10.1200/JCO.2005.03.2946. [10] Seute T, Leffers P, ten Velde GP, et al. Detection of brain metastases from small cell lung cancer:consequences of changing imaging techniques (CT versus MRI)[J]. Cancer, 2008, 112(8):1827-1834. DOI:10.1002/cncr.23361. [11] Manapov F, Klautke G, Fietkau R. Prevalence of brain metastases immediately before prophylactic cranial irradiation in limited disease small cell lung cancer patients with complete remission to chemoradiotherapy:a single institution experience[J]. J Thorac Oncol, 2008, 3(6):652-655. DOI:10.1097/JTO.0b013e3181757a76. [12] Yilmaz U, Kirakli EK, Gurlek U, et al. Frequency of silent brain metastasis before prophylactic cranial irradiation in small cell lung cancer[J]. Turk Thorac J, 2017, 18(1):11-13. DOI:10.5152/TurkThoracJ.2017.16022. [13] Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer[J]. N Engl J Med, 2007, 357(7):664-672. DOI:10.1056/NEJMoa071780. [14] Takahashi T, Yamanaka T, Seto T, et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer:a multicentre, randomised, open-label, phase 3 trial[J]. Lancet Oncol, 2017, 18(5):663-671. DOI:10.1016/S1470-2045(17)30230-9. [15] Farris MK, Wheless WH, Hughes RT, et al. Limited-stage small cell lung cancer:is prophylactic cranial irradiation necessary?[J]. Pract Radiat Oncol, 2019, 9(6):e599-e607. DOI:10.1016/j.prro.2019.06.014. [16] Mamesaya N, Wakuda K, Omae K, et al. Efficacy of prophylactic cranial irradiation in patients with limited-disease small-cell lung cancer who were confirmed to have no brain metastasis via magnetic resonance imaging after initial chemoradiotherapy[J]. Oncotarget, 2018, 9(25):17664-17674. DOI:10.18632/oncotarget.24830. [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[J]. BMC Cancer, 2015, 15:589. DOI:10.1186/s12885-015-1593-2. [18] Le Pechoux C, Botticella A, Levy A, et al. Prophylactic cranial irradiation or no prophylactic cranial irradiation in metastatic small cell lung cancer:is it a relevant question once again?[J]. J Thorac Dis, 2017, 9(11):4157-4161. DOI:10.21037/jtd.2017.10.10. [19] Rusthoven CG, Kavanagh BD. Prophylactic cranial irradiation (PCI) versus active mri surveillance for small cell lung cancer:the case for equipoise[J]. J Thorac Oncol, 2017, 12(12):1746-1754. DOI:10.1016/j.jtho.2017.08.016.
2021, Vol. 30 
