Prophylactic cranial irradiation for extensive-stage small cell lung cancer: Analysis based on active brain MRI surveillance

Jing Yu, Wen Ouyang, Yong Yang, Xiaoyue Zhang, Yan Zhou, Junhong Zhang, Conghua Xie, Jing Yu, Wen Ouyang, Yong Yang, Xiaoyue Zhang, Yan Zhou, Junhong Zhang, Conghua Xie

Abstract

Background and purpose: The value of prophylactic cranial irradiation (PCI) for extensive-stage small-cell lung cancer (ES-SCLC) has recently been challenged. This study was conducted to evaluate the role of PCI for ES-SCLC under active brain magnetic resonance imaging (MRI) surveillance.

Materials and methods: Patients with ES-SCLC who showed any responses after first-line chemotherapy and no initial brain metastasis (BM) were retrospectively included. Active brain MRI surveillance was performed for all patients. Progression-free survival (PFS) and overall survival (OS) were compared between PCI and non-PCI patients. The time-related hazard of BM was evaluated in non-PCI patients.

Results: One hundred and eighteen consecutive patients were included in the study. The median follow-up time was 26.5 months (3-72 months). The median PFS and OS were better in the PCI cohort than in the non-PCI group. Multivariate analyses revealed first-line chemotherapy cycles (> 4 vs. ≤ 4 cycles, HR: 0.29; 95% CI: 0.15-0.55, P < 0.01) and PCI (Yes vs. No, HR: 0.54; 95% CI: 0.29-0.99, P = 0.04) were independent prognostic factors for disease progression. In the non-PCI group, 47.4% (46/97) of the patients developed BM and the hazard of BM increased continuously in three-quarters of the first year since diagnosis.

Conclusion: Under active brain MRI surveillance, PCI could be beneficial for patients with ES-SCLC who show good responses after first-line chemotherapy.

Keywords: Extensive stage small-cell lung cancer; MRI surveillance; Prophylactic cranial irradiation.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2020 The Authors.

Figures

Fig. 1
Fig. 1
A, Comparison of PFS between PCI and non-PCI ES-SCLC patients, B, Comparison of OS between PCI and non-PCI ES-SCLC patients. PFS, progression-free survival; OS, overall survival; PCI, prophylactic cranial irradiation; ES-SCLC, extensive-stage small cell lung cancer.
Fig. 2
Fig. 2
Multivariate analysis and forest plots indicating the independent prognostic factors for PFS and OS in ES-SCLC patients. PFS, progression-free survival, OS, overall survival; ES-SCLC, extensive-stage small cell lung cancer, HR, hazard ratio; CI, confidence interval.
Fig. 3
Fig. 3
Comparison of BSS between PCI and non-PCI ES-SCLC patients. BSS, brain progression-specific survival; ES-SCLC, extensive-stage small cell lung cancer; PCI, prophylactic cranial irradiation.
Fig. 4
Fig. 4
A, Smoothed hazard plots for the monthly rate of brain metastasis for ES-SCLC without PCI; B, the cumulative incidence of brain metastases of ES-SCLC without PCI. ES-SCLC, extensive-stage small cell lung cancer; PCI, prophylactic cranial irradiation.

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Source: PubMed

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