A study of the prognosis of patients with limited-stage small cell lung cancer who did or did not receive prophylactic cranial irradiation after effective chemoradiotherapy

Qing Wu; Mengyuan Chen; Fang Peng; Qun Zhang; Yue Kong; Yong Bao; Yujin Xu; Xiao Hu; Ming Chen

doi:10.3389/fonc.2023.1118371

A study of the prognosis of patients with limited-stage small cell lung cancer who did or did not receive prophylactic cranial irradiation after effective chemoradiotherapy

Front Oncol. 2023 Mar 23:13:1118371. doi: 10.3389/fonc.2023.1118371. eCollection 2023.

Authors

Qing Wu^{1

2}, Mengyuan Chen², Fang Peng³, Qun Zhang³, Yue Kong², Yong Bao³, Yujin Xu², Xiao Hu², Ming Chen⁴

Affiliations

¹ The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
² Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China.
³ Department of Radiotherapy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
⁴ Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.

Abstract

Objective: To investigate the prognosis of patients with LS-SCLC who responded to chest chemoradiotherapy but did not receive PCI.

Methods: A retrospective analysis was conducted on LS-SCLC patients who had achieved complete remission (CR) or partial remission (PR) after definitive chemoradiotherapy but did not receive PCI. The survival rates were calculated using Kaplan-Meier method. The prognosis was analyzed using Cox proportional hazard regression model. The main endpoint was OS.

Results: Of the 500 patients with LS-SCLC admitted between June 2002 and January 2018, 327 achieved CR or PR after definitive chest chemoradiotherapy, 103 did not receive PCI, and 63 of them developed brain metastases (BM). The 1-year and 3-year OS rates in PCI group were 87.5% and 42.3% respectively, versus 70.4% and 20.9% for non-PCI group(P=0.002). The median survival time after BM was 8.7 months (range: 0.3-48.7), and 3-year OS rate was 15.0%, the median survival time of patients without BM was 20.1 months (range: 2.9-79.4), and 3-year OS was 33.4% (P=0.014). Patients with BM were subsequently treated with palliative therapy. Multivariate analysis showed that compared with no treatment, brain radiotherapy alone (HR: 0.131, 95%CI: 0.035-0.491, P=0.003) and radiotherapy combined with chemotherapy (HR: 0.039, 95%CI: 0.008-0.194, P<0.001) significantly reduced the risk of death. Multiple BM (HR: 2.391, 95%CI: 1.082-5.285, P=0.031) was an independent adverse prognostic factor for OS.

Conclusion: LS-SCLC patients who achieved good response after chest chemoradiotherapy without receiving PCI were prone to develop BM and have a poor prognosis. Multiple BM was an independent adverse prognostic factor. PCI remains the standard of care for LS-SCLC patients.

Keywords: brain metastases; limited-stage; prophylactic cranial irradiation; small cell lung cancer; study on the prognosis.

Grants and funding

This study was funded by the National Natural Science Foundation of China (grant numbers 81402540 and 81672972), the National Health Commission scientific research funds—Zhejiang province major science and technology project on medicine (grant number WKJ-ZJ-1701), and Zhejiang Science and Technology Plan on Medicine and Health (grant number 2019KY046, 2022KY618, 2023KY610) and Zhejiang Key Research and Development Plan “Medical Artificial Intelligence Technology and System Development - Research on Key Technologies of Intelligent Radiotherapy” (2019C03003). Zhejiang Cancer Hospital Special Program of Investigator-Initiated Clinical Trial (grant number IIT2022ZA005).