Early versus late prophylactic cranial irradiation in patients with extensive small cell lung cancer

  • Yi Chen
  • Jinyu Li
  • Yibao Zhang
  • Yi Hu
  • Guoqing Zhang
  • Xiang Yan
  • Zhi Lin
  • Zhifei Zhao
  • Shunchang Jiao
Original Article
  • 20 Downloads

Abstract

Objective

Previous studies demonstrated that prophylactic cranial irradiation (PCI) significantly reduced the incidence of brain metastases in patients with extensive disease small cell lung cancer (ED-SCLC). However, the appropriate timing for PCI in treating ED-SCLC is still unclear. This study aimed to compare the effect and safety of early versus late PCI.

Methods

Between November 2011 and July 2016, 103 patients with ED-SCLC were reviewed, receiving appropriate imaging tests to exclude brain metastases prior to cranial irradiation. Of these 103 patients, early PCI was performed in 47 patients and the other 56 patients received late PCI. The primary endpoint was the incidence of brain metastases. The progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were also assessed.

Results

Early PCI significantly lowered the risk of brain metastases, as compared to late PCI (p = 0.024). Additionally, multivariate analyses demonstrated that early PCI was a favorable independent predictor of the incidence of brain metastases. The PFS and OS of patients in the early and late PCI groups were comparable (PFS: 8.4 months vs. 7.5 months, p = 0.234; OS: 16.1 months vs. 15.2 months, p = 0.753). The AEs were generally acceptable in both groups.

Conclusion

To reduce the incidence of brain metastases, early PCI is more effective than late PCI for ED-SCLC patients.

Keywords

Small cell lung carcinoma Chemotherapy Radiotherapy Metastases Dose fractionation 

Frühe vs. späte prophylaktische kraniale Bestrahlung bei Patienten mit metastasiertem kleinzelligem Lungenkarzinom

Zusammenfassung

Zusammenfassung

In früheren Studien wurde gezeigt, dass eine prophylaktische Ganzhirnbestrahlung („prophylactic cranial irradiation“, PCI) die Häufigkeit zerebraler Metastasen im Gehirn bei Patienten mit metastasiertem kleinzelligem Lungenkarzinom („extensive disease small cell lung cancer“, ED-SCLC) signifikant reduzieren kann. Der richtige Zeitpunkt einer PCI bei ED-SCLC ist unklar. Ziel dieser Studie ist es, die Wirkung und Sicherheit von früher vs. später PCI zu vergleichen.

Methode

Zwischen November 2011 und Juli 2016 wurden 103 Patienten mit ED-SCLC untersucht. Mittels schnittbildgebender Untersuchung wurden Hirnmetastasen vor der Ganzhirnbestrahlung ausgeschlossen. Bei 47 Patienten wurde eine frühe PCI durchgeführt, bei den anderen 56 Patienten eine späte PCI. Primärer Endpunkt war das Auftreten von Hirnmetastasen. Das progressionsfreie Überleben („progression-free survival“, PFS), Gesamtüberleben („overall survival“, OS) und unerwünschte Ereignisse („adverse events“, AE) wurden ebenfalls ausgewertet.

Ergebnisse

Eine frühe PCI senkt das Risiko für Hirnmetastasen im Vergleich zur späten PCI (p = 0,024). Zusätzlich zeigen multivariate Analysen, dass eine frühe PCI ein unabhängiger Prädiktor für das seltenere Auftreten von zerebralen Filiae war. PFS und OS waren bei Patienten mit früher und später PCI vergleichbar (PFS: 8,4 vs. 7,5 Monate; p = 0,234; OS: 16,1 vs. 15,2 Monate; p = 0,753). Die AE waren in beiden Gruppen tolerabel.

Schlussfolgerung

Um die Auftretenswahrscheinlichkeit von Metastasen im Gehirn zu reduzieren, ist eine frühe PCI effektiver als eine späte PCI bei Patienten mit ED-SCLC.

Schlüsselwörter

Kleinzelliges Lungenkarzinom Chemotherapie Strahlentherapie Metastasen Dosisfraktionierung 

Notes

Acknowledgements

This work was jointly supported by National Natural Science Foundation of China (Grants No. 11505012), Beijing Natural Science Foundation (Grants No. 7172048, 1174016 and 1184014), and Capital’s Funds for Health Improvement and Research (2018-4-1027).

Conflict of interest

Y. Chen, J. Li, Y. Zhang, Y. Hu, G. Zhang, X. Yan, Z. Lin, Z. Zhao, and S. Jiao declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Clinical MedicineTsinghua UniversityBeijingChina
  2. 2.Department of Medical OncologyChinese PLA General HospitalBeijingChina
  3. 3.Department of Radiotherapy, Peking University Cancer Hospital & InstituteKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)BeijingChina
  4. 4.Department of Radiation OncologyChinese PLA General HospitalBeijingChina
  5. 5.BeijingChina

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