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Comparison of the Effectiveness of “Late” and “Early” Prophylactic Cranial Irradiation in Patients with Limited-Stage Small Cell Lung Cancer

Vergleich der Effektivität von „später“ und „früher“ prophylaktischer Ganzhirnbestrahlung bei Patienten mit kleinzelligem Bronchialkarzinom im Limited-Disease-Stadium

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Purpose:

To evaluate the effectiveness of timing of application of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer in limited stage of disease (LS SCLC).

Patients and Methods:

Between 1995 and 2004, 129 patients with LS SCLC were treated within two consecutive phase II studies assessing different schedules of combined treatment. All patients received chemotherapy and concurrent thoracic radiotherapy. In 86 patients (66.7%) who developed complete response in the thorax, PCI was performed either after chemoradiotherapy (“late” PCI , n = 45 [52.4%]) or during chemoradiotherapy (“early” PCI, n = 41 [47.7%]). In the latter case, PCI was given immediately after the end of thoracic radiotherapy and prior to the last cycles of chemotherapy to a total dose of 30 Gy in 2-Gy fractions to the whole brain. The results were evaluated with regard to 4-year rates of overall survival, disease-free survival, and brain metastases-free survival. Additionally, the prognostic role of PCI application and its time delay in relation to survival rates and incidence of brain metastases was estimated.

Results:

The 4-year survival rates were 25.5% for overall survival, 26.8% for disease-free survival, and 67.8% for brain metastases- free survival. During the observation period, 32 patients (24.8%) developed brain metastases, which occured in 20 of 43 patients (46.5%) without and only in twelve out of 86 patients (14%) with PCI. The 4-year brain metastases-free survival rates were 81.8%, if PCI was applied, versus 32.2%, if no such procedure was used (for p = 0.0000). The timing of PCI appeared to be an important factor in terms of decreasing the incidence of brain metastases.

Conclusion:

PCI significantly decreases the incidence of brain metastases and delays their development in patients with LS SCLC. “Early” PCI is more effective than PCI applied after combined therapy.

Ziel:

Evaluation der Effektivitat einer korrekten zeitlichen Planung einer prophylaktischen Ganzhirnbestrahlung (PCI) bei Patienten mit kleinzelligem Bronchialkarzinom im Limited-Disease-Stadium (LS-SCLC).

Patienten und Methodik:

Zwischen 1995 und 2004 wurden 129 Patienten mit LS-SCLC in zwei aufeinanderfolgenden Phase-II-Studien behandelt, in denen zu unterschiedlichen Zeitpunkten eine Kombinationstherapie verabreicht wurde. Alle Patienten erhielten eine Chemotherapie mit gleichzeitiger thorakaler Bestrahlung. 86 Patienten (66,7%), die eine positive Reaktion im Thorax entwickelten, wurden einer PCI unterzogen, wobei diese in 45 Fallen (52,4%) nach der Radiochemotherapie („spate“ PCI) und in den restlichen 41 Fallen (47,7%) während derselben („fruhe“ PCI) durchgeführt wurde. In letzterem Fall wurde die PCI unmittelbar nach Beendigung der Thoraxbestrahlung vor den letzten Chemotherapiezyklen in einer Gesamtdosis von 30 Gy in 2-Gy-Fraktionen auf das gesamte Gehirn verabreicht. Die Ergebnisse wurden in Bezug auf die 4-Jahres-Raten des Gesamtüberlebens, des krankheitsfreien Überlebens und des hirnmetastasenfreien Überlebens beurteilt. Zusatzlich wurde die prognostische Rolle der PCI-Anwendung und deren zeitlicher Verzogerung im Hinblick auf Überlebensraten und Inzidenz von Hirnmetastasen bewertet.

Ergebnisse:

Die 4-Jahres-Überlebensraten betrugen 25,5% fur das Gesamtüberleben, 26,8% fur das krankheitsfreie Überleben und 67,8% fur das hirnmetastasenfreie Überleben. Bei 32 Patienten (24,8%) traten während des Beobachtungszeitraums Hirnmetastasen auf, die sich bei 20 von 43 Patienten (46,5%) ohne und lediglich bei zwölf von 86 Patienten (14%) mit PCI entwickelten. Die hirnmetastasenfreie 4-Jahres-Überlebensrate betrug bei Einsatz der PCI 81,8% gegenüber 32,2% bei den Patienten, die keine PCI erhielten (fur p = 0,0000). Der richtige Zeitpunkt der Durchführung einer PCI erwies sich als wichtiger Faktor fur die Abnahme der Inzidenz von Hirnmetastasen.

Schlussfolgerung:

Eine PCI senkt die Inzidenz von Hirnmetastasen signifikant und verzogert deren Entwicklung bei Patienten mit LS-SCLC. Eine „fruhe“ PCI ist effektiver als eine nach Kombinationstherapie durchgeführte PCI.

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Authors and Affiliations

  1. Breast and Chest Department, Center of Oncology – Maria Skłodowska-Curie Memorial Institute, Krakow, Poland

    Beata Sas-Korczyńska MD & Stanisław Korzeniowski

  2. Clinical Biochemistry Department, Center of Oncology – Maria Skłodowska-Curie Memorial Institute, Krakow, Poland

    Ewa Wójcik

  3. Breast and Chest Department, Center of Oncology – Maria Skłodowska-Curie Memorial Institute, Ul. Garncarska 11, 31-115, Kraków, Poland

    Beata Sas-Korczyńska MD

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  1. Beata Sas-Korczyńska MD
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  2. Stanisław Korzeniowski
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  3. Ewa Wójcik
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Correspondence to Beata Sas-Korczyńska MD.

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Sas-Korczyńska, B., Korzeniowski, S. & Wójcik, E. Comparison of the Effectiveness of “Late” and “Early” Prophylactic Cranial Irradiation in Patients with Limited-Stage Small Cell Lung Cancer. Strahlenther Onkol 186, 315–319 (2010). https://doi.org/10.1007/s00066-010-2088-3

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  • DOI: https://doi.org/10.1007/s00066-010-2088-3

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