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

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

doi:10.1016/j.cllc.2016.11.005

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

Clin Lung Cancer. 2017 Jul;18(4):e243-e249. doi: 10.1016/j.cllc.2016.11.005. Epub 2016 Nov 21.

Authors

Chukwuka Eze¹, Olarn Roengvoraphoj¹, Maximilian Niyazi¹, Guido Hildebrandt², Rainer Fietkau³, Claus Belka⁴, Farkhad Manapov⁵

Affiliations

¹ Department of Radiation Oncology, LMU Munich, Munich, Germany.
² Department of Radiation Oncology, University of Rostock, Rostock, Germany.
³ Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany.
⁴ Department of Radiation Oncology, LMU Munich, Munich, Germany; Comprehensive Pneumology Center, The German Center for Lung Research, Munich, Germany.
⁵ Department of Radiation Oncology, LMU Munich, Munich, Germany. Electronic address: Farkhad.Manapov@med.uni-muenchen.de.

PMID: 28065620
DOI: 10.1016/j.cllc.2016.11.005

Abstract

Introduction: Prophylactic cranial irradiation (PCI) has proven to decrease the incidence of brain metastases (BMs), with a modest improvement in survival.

Patients and methods: The impact of PCI was evaluated in 184 patients treated with chemoradiotherapy. PCI was applied to patients with disease with partial and complete response only when cranial magnetic resonance imaging before and after primary treatment revealed no BMs. Correlation between PCI and overall survival (OS), BM-free survival (BMFS), and time to progression (TTP) was analyzed to describe survival within subgroups.

Results: Concurrent and sequential chemoradiotherapy was applied in 71 patients (39%) and 113 patients (61%), respectively. Seventy-one patients (39%) with partial and complete response were treated with PCI. Metachronous BMs were detected in 16 (23%) of 71 patients in the PCI group compared to 42 (37%) of 113 patients in the non-PCI group. Median BMFS in the PCI group was not reached; it was 23.6 months in the non-PCI group. Median OS and TTP were 26 months (range, 19.4-32.6 months) in the PCI group versus 14 months (range, 11.4-16.6 months) in patients without PCI whose disease responded to therapy versus 9 months in patients with disease that did not respond to therapy (P < .0001), and 27 versus 14.5 months (range, 9.0-19.9 months) versus 8.8 months (range, 7.7-9.9 months) (P < .0001) in the PCI group versus those with response without PCI versus those with nonresponse. The effect of PCI was independent of gender. On multivariate analysis, PCI was a variable correlating with OS (hazard ratio = 1.899; 95% confidence interval, 1.370-2.632; P < .0001) and TTP (hazard ratio = 2.164; 95% confidence interval, 1.371-3.415; P = .001) after adjustment for other prognostic factors.

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

Keywords: Brain metastasis; Chemoradiotherapy; PCI; SCLC; Survival.

MeSH terms

Adult
Aged
Aged, 80 and over
Brain Neoplasms / mortality
Brain Neoplasms / prevention & control*
Brain Neoplasms / secondary
Chemoradiotherapy*
Cohort Studies
Female
Follow-Up Studies
Humans
Lung Neoplasms / mortality
Lung Neoplasms / pathology
Lung Neoplasms / therapy*
Magnetic Resonance Imaging
Male
Middle Aged
Prognosis
Skull / diagnostic imaging
Skull / pathology
Skull / radiation effects*
Small Cell Lung Carcinoma / mortality
Small Cell Lung Carcinoma / secondary
Small Cell Lung Carcinoma / therapy*
Survival Analysis
Treatment Outcome