Effect of Prophylactic Cranial Irradiation on Overall Survival in Metastatic Small-Cell Lung Cancer: A Propensity Score-Matched Analysis.

Published on May 1, 2018in Clinical Lung Cancer4.785
· DOI :10.1016/J.CLLC.2017.12.003
Sonam Sharma10
Estimated H-index: 10
(UPenn: University of Pennsylvania),
Matthew T. McMillan25
Estimated H-index: 25
(UPenn: University of Pennsylvania)
+ 5 AuthorsJacob E. Shabason13
Estimated H-index: 13
(UPenn: University of Pennsylvania)
Sources
Abstract
Abstract Introduction Patients with small-cell lung cancer (SCLC) have a high incidence of occult brain metastases and are often treated with prophylactic cranial irradiation (PCI). Despite a small survival advantage in some studies, the role of PCI in extensive stage SCLC remains controversial. We used the National Cancer Database to assess survival of patients with metastatic SCLC treated with PCI. Patients and Methods Metastatic SCLC patients without brain metastases were identified. To minimize treatment selection bias, patients with an overall survival (OS)  Results In the overall cohort (n = 4257), treatment with PCI (n = 473) was associated with improved survival (hazard ratio, 0.66; 95% confidence interval, 0.60-0.74; P  Conclusion Using a modern population-based data set, we showed that metastatic SCLC patients treated with PCI have significantly improved OS. This large retrospective study helps address the conflicting prospective data.
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#2Takeharu Yamanaka (YCU: Yokohama City University)H-Index: 46
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Summary Background Results from a previous phase 3 study suggested that prophylactic cranial irradiation reduces the incidence of symptomatic brain metastases and prolongs overall survival compared with no prophylactic cranial irradiation in patients with extensive-disease small-cell lung cancer. However, because of the absence of brain imaging before enrolment and variations in chemotherapeutic regimens and irradiation doses, concerns have been raised about these findings. We did a phase 3 tria...
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#1Aditya Jain (OHSU: Oregon Health & Science University)H-Index: 2
#2Jia Luo (OHSU: Oregon Health & Science University)H-Index: 11
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Abstract Introduction Conflicting data from randomized clinical trials incite the debate over the appropriate use of prophylactic cranial irradiation (PCI) for patients with extensive-stage SCLC (ES-SCLC) who achieve clinical response to systemic chemotherapy. The current pattern of practice among U.S. radiation oncologists is unknown. Methods We surveyed practicing U.S. radiation oncologists through a short online questionnaire. Respondents' characteristics and their self-rated knowledge base w...
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#1Cécile Le PéchouxH-Index: 49
#2Alexander Sun (Princess Margaret Cancer Centre)H-Index: 26
Last. Elizabeth Gore (MCW: Medical College of Wisconsin)H-Index: 34
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Summary The incidence of brain metastases in patients with lung cancer has increased as a result of improved local and systemic control and better diagnosis from advances in brain imaging. Because brain metastases are responsible for life-threatening symptoms and serious impairment of quality of life, resulting in shortened survival, prophylactic cranial irradiation has been proposed in both small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) to try to improve incidence of brain...
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#1Jeevin Shahi (McMaster University)H-Index: 3
#2James R. Wright (HHS: Hamilton Health Sciences)H-Index: 17
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Background The management of small-cell lung cancer (SCLC) with radiotherapy (RT) varies, with many treatment regimens having been described in the literature. We created a survey to assess patterns of practice and clinical decision-making in the management of SCLC by Canadian radiation oncologists (ROS). Methods A 35-item survey was sent by e-mail to Canadian ROS. The questions investigated the role of RT, the dose and timing of RT, target delineation, and use of prophylactic cranial irradiatio...
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Abstract Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Can...
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Background The rate of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer has increased over the past decade, particularly for young women. This study investigates the impact of race and socioeconomic status (SES) on use of CPM. Study Design Using the National Cancer Data Base (NCDB), we selected 1,781,409 stage 0 to II unilateral breast cancer patients between 1998 and 2011. Trends in use of CPM by race and SES were analyzed using chi-square tests and logistic regression m...
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#1Eileen O'Keefe (BU: Boston University)H-Index: 6
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Declining cancer incidence and mortality rates in the United States (U.S.) have continued through the first decade of the twenty-first century. Reductions in tobacco use, greater uptake of prevention measures, adoption of early-detection methods, and improved treatments have resulted in improved outcomes for both men and women. However, Black Americans continue to have the higher cancer mortality rates and shorter survival times. This review discusses and compares the cancer mortality rates and ...
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#2Harm van Tinteren (NKI-AVL: Netherlands Cancer Institute)H-Index: 67
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Summary Background Most patients with extensive stage small-cell lung cancer (ES-SCLC) who undergo chemotherapy, and prophylactic cranial irradiation, have persistent intrathoracic disease. We assessed thoracic radiotherapy for treatment of this patient group. Methods We did this phase 3 randomised controlled trial at 42 hospitals: 16 in Netherlands, 22 in the UK, three in Norway, and one in Belgium. We enrolled patients with WHO performance score 0–2 and confirmed ES-SCLC who responded to chemo...
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Purpose Hippocampal neural stem-cell injury during whole-brain radiotherapy (WBRT) may play a role in memory decline. Intensity-modulated radiotherapy can be used to avoid conformally the hippocampal neural stem-cell compartment during WBRT (HA-WBRT). RTOG 0933 was a single-arm phase II study of HA-WBRT for brain metastases with prespecified comparison with a historical control of patients treated with WBRT without hippocampal avoidance.
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The role of prophylactic cranial irradiation (PCI) and thoracic radiation therapy (TRT) in extensive-stage small cell lung cancer remains controversial. The authors examined the National Cancer Database and identified patients with extensive-stage small cell lung cancer with no brain metastasis. Patients were excluded if they died 30 days from diagnosis, did not receive polychemotherapy, had other palliative radiation or had missing information. A propensity score-matched analysis was also perfo...
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Abstract Purpose: Conflicting data exists regarding the benefit of prophylactic cranial irradiation (PCI) in patients with extensive stage small cell lung cancer (ES-SCLC). We sought to retrospectively review outcomes of patients within our network with ES-SCLC treated with and without PCI between 2009 and 2020. Methods: Endpoints assessed using the Kaplan-Meier estimator were overall survival (OS), freedom from death with uncontrolled intracranial disease (UI-DFS), brain metastasis-free surviva...
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#2Mieke J. AartsH-Index: 17
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Abstract Introduction Controversy has arisen regarding the benefit of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC), particularly since the 2017 Takahashi trial publication that supports MRI surveillance in extensive-stage (ES-)SCLC. The primary aim of this study was to assess trends and determinants in PCI use over the years 2010–2018. A secondary aim was to determine contemporary practice considerations among radiation oncologists (ROs). Methods A nation...
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Abstract Purpose The role of prophylactic cranial irradiation (PCI) in treatment of extensive-stage small-cell lung cancer (SCLC) is controversial. The aim of this study was to systematically evaluate the efficacy and safety of using PCI in the treatment of extensive-stage SCLC. In the present study, we examined whether PCI was essential for the optimal treatment of extensive-disease small-cell lung cancer. Material and methods We searched the PubMed, Embase, Medline, and China National Knowledg...
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Abstract Extensive disease Small cell lung cancer (ED-SCLC) represents a very aggressive malignancy in which brain metastases (BM) are quite common. Clinical trials on prophylactic cranial irradiation (PCI) have showed a clear decrease in the risk of developing BM but conflicting results concerning a possible survival advantage. A landmark European Organisation for Research and Treatment of Cancer (EORTC) prospective trial, as well as multitude of retrospective series confirm survival benefit af...
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Purpose of reviewThe current article reviews the state of art of prevention strategies for brain metastases from solid tumors and touches both old pivotal studies and new directions of personalized molecular approaches.Recent findingsProphylactic cranial irradiation (PCI) has a definite role in the
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The treatment of malignant tumors has considerably improved in recent years, and also the number of “long term cancer survivors” is increasing.
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