Abstract
BackgroundProphylactic cranial irradiation (PCI) is recommended for patients with limited-disease small-cell lung cancer (LD-SCLC) who achieved good response to definitive chemoradiotherapy. However, most clinical studies lacked brain imaging scans before PCI. Our study aimed to investigate whether PCI has a survival benefit in patients who have no brain metastases (BM) confirmed via magnetic resonance imaging (MRI) before PCI.ResultsEighty patients were included in this study. Sixty patients received PCI (PCI group) and 20 patients did not (non-PCI group). OS was not significantly different between the two groups. The median OS time was 4.3 years (95% CI: 2.6 years–8.6 years) in the PCI group and was not reached (NR) (95% CI: 1.9 years–NR) in the non-PCI group (p = 0.542). Moreover, no differences were observed in the 3-year rates of PFS (46.2% and 44.4%, p = 0.720) and cumulative incidence of BM (24.0% vs. 27%, p = 0.404).ConclusionsOur result suggests that PCI may not have a survival benefit in patients with LD-SCLC confirmed to have no BM after initial therapy, even if patients achieve a good response to definitive chemoradiotherapy.Patients and MethodsWe retrospectively evaluated patients with LD-SCLC who were confirmed to have no BM via MRI after initial chemoradiotherapy at the Shizuoka Cancer Center between September 2002 and August 2015. The overall survival (OS), progression-free survival (PFS), and cumulative incidence of BM were estimated using the Kaplan–Meier method between patients who received PCI and those who did not. Propensity score matching was used to balance baseline characteristics.
Highlights
Small-cell lung cancer (SCLC) is a rapidly disseminating cancer accounting for 13%–15% of all lung cancers [1, 2]
Our result suggests that Prophylactic cranial irradiation (PCI) may not have a survival benefit in patients with limited disease (LD)-SCLC confirmed to have no brain metastases (BM) after initial therapy, even if patients achieve a good response to definitive chemoradiotherapy
Our study is valuable because this is the first study in terms of asymptomatic BM during treatment in patients with limited-disease small-cell lung cancer (LD-SCLC) receiving PCI. The results of this retrospective study suggest that PCI may have a clinical benefit for survival and the BM incidence in patients with LD-SCLC confirmed with no BM before PCI, even if patients achieve a good response to definitive chemoradiotherapy
Summary
Small-cell lung cancer (SCLC) is a rapidly disseminating cancer accounting for 13%–15% of all lung cancers [1, 2]. The relative risk of death in the PCI group was 0.84 (95% CI: 0.73– 0.97; p = 0.01), which corresponds to a 5.4% absolute increase in 3-year survival (no-PCI group, 15.3%; PCI group, 20.7%) Based on this meta-analysis, the American Society of Clinical Oncology recommended PCI for patients with SCLC who achieve CR or partial response (PR) to initial therapy [17]. A Japanese phase III randomized trial showed that PCI can reduce the incidence of BM but cannot improve the 3-year OS among patients with extensive disease-small cell lung cancer (ED-SCLC) confirmed to have no BM via magnetic resonance imaging (MRI) before receiving PCI [18]. Prophylactic cranial irradiation (PCI) is recommended for patients with limited-disease small-cell lung cancer (LD-SCLC) who achieved good response to definitive chemoradiotherapy. Our study aimed to investigate whether PCI has a survival benefit in patients who have no brain metastases (BM) confirmed via magnetic resonance imaging (MRI) before PCI
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