Management of brain metastasis with magnetic resonance imaging and stereotactic irradiation attenuated benefits of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer.

Yuichi Ozawa,Naoki Inui,Masato Kato,Koshi Yokomura,Masato Fujii,Takafumi Suda,Masato Karayama,Shinya Sagisaka,Kazumasa Yasuda,Kazunari Yamada,Takashi Matsui,Yutaro Nakamura,Kazuhiro Asada,Minako Omae,Toshihiro Shirai

doi:10.1186/s12885-015-1593-2

Abstract

BackgroundMagnetic resonance imaging (MRI) enables a more sensitive detection of brain metastasis and stereotactic irradiation (SRI) efficiently controls brain metastasis. In limited-stage small cell lung cancer (LS-SCLC), prophylactic cranial irradiation (PCI) in patients with good responses to initial treatment is recommended based on the survival benefit shown in previous clinical trials. However, none of these trials evaluated PCI effects using the management of brain metastasis with MRI or SRI. This study aimed to determine the effects of MRI and SRI on the benefits of PCI in patients with LS-SCLC.MethodsThe clinical records of pathologically proven SCLC from January 2006 to June 2013 in facilities equipped with or had access to SRI in Japan were retrospectively reviewed. Patients with LS-SCLC and complete or good partial responses after initial treatment were included in the study and analyzed by the Kaplan-Meier method.ResultsOf 418 patients with SCLC, 124 met criteria and were divided into patients receiving PCI (PCI group; n = 29) and those without PCI (non-PCI groups; n = 95). At baseline, ratios of patients with stage III were significantly advantageous for the non-PCI group, although younger age and high ratios of complete response and MRI confirmed absence of brain metastasis were advantageous for the PCI group. Neither median survival times (25 vs. 34 months; p = 0.256) nor cumulative incidence of brain metastasis during 2 years (45.5 vs. 30.8 %; p = 0.313) significantly differed between the two groups. Moreover, these factors did not significantly differ among patients with stage III disease (25 vs. 26 months; p = 0.680, 42.3 vs. 52.3 %; p = 0.458, respectively).ConclusionPCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available.

Highlights

Magnetic resonance imaging (MRI) enables a more sensitive detection of brain metastasis and stereotactic irradiation (SRI) efficiently controls brain metastasis
Manapov et al reported that cranial MRI immediately before prophylactic cranial irradiation (PCI) detected brain metastasis (BM) in 32.5 % of patients with LSSCLC who had been assessed with complete response (CR) [22]
The ratio of clinical stage III patients was significantly higher in the PCI group than the non-PCI (82.8 vs. 51.6 %; p = 0.0009), which would be advantageous for the latter group, most other significant or non-significant differences between the two groups, including younger age (65 vs. 74; p < 0.0001) and a higher ratio of CR (86.2 vs. 60.0 %; p = 0.0052), were advantageous for the PCI group (Table 1)

Summary

Introduction

Magnetic resonance imaging (MRI) enables a more sensitive detection of brain metastasis and stereotactic irradiation (SRI) efficiently controls brain metastasis. In limited-stage small cell lung cancer (LS-SCLC), prophylactic cranial irradiation (PCI) in patients with good responses to initial treatment is recommended based on the survival benefit shown in previous clinical trials. None of these trials evaluated PCI effects using the management of brain metastasis with MRI or SRI. Several clinical trials have evaluated the efficacy of prophylactic cranial irradiation (PCI), and most have shown significant reductions in the occurrence of BM and survival improvement in patients with limitedstage SCLC (LS-SCLC) and good responses to initial treatment [1,2,3,4]. No studies evaluated PCI effects in such a cohort

Objectives

Methods

Results

Discussion

Conclusion