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Prophylactic cranial irradiation could improve overall survival in patients with extensive small cell lung cancer

A retrospective study

Verbesserung der Gesamtüberlebenszeit durch prophylaktische kraniale Bestrahlung bei Patienten mit ausgedehntem kleinzelligem Bronchialkarzinom

Eine retrospektive Studie

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Abstract

Objective

To evaluate the effect of prophylactic cranial irradiation (PCI) on overall survival (OS) in patients with extensive small cell lung cancer (ESCLC).

Methods

Between April 2005 and May 2014, 204 patients with ESCLC who had any response (according to RECIST 1.1) to initial chemotherapy were reviewed. All patients had undergone appropriate imaging tests to exclude brain metastases before initial chemotherapy. PCI was performed on 45 patients (22.1 %) and the remaining patients (77.9 %) received no such treatment (control group). Primary endpoint was OS. The incidence of brain metastases, brain metastases-free survival (BMFS), and adverse effects were also evaluated.

Results

Survival data of the 204 patients were analyzed statistically. PCI significantly prolonged median OS from 12.6 to 16.5 months as compared to the control group (hazard ratio, HR, 0.63; 95 % confidence interval, CI, 0.41 to 0.96; p = 0.033). PCI significantly lowered the risk of brain metastases (HR 0.48; 95 % CI 0.30 to 0.76; p = 0.001). The 1‑year incidence of brain metastases was 17.1 and 55.9 % in the PCI and control group, respectively. PCI significantly correlated with the increased median BMFS (p = 0.002). Additionally, multivariate analyses demonstrated that PCI was a favorable independent predictor of OS, BMFS, and the incidence of brain metastases. Acute and chronic adverse effects were generally low grade and well tolerated in patients receiving PCI.

Conclusion

PCI after any response to initial chemotherapy significantly improved OS of ESCLC patients analyzed in this study.

Zusammenfassung

Ziel

Beurteilung des Effekts der prophylaktischen kranialen Bestrahlung (PCI) auf das Gesamtüberleben (OS) bei Patienten mit ausgedehntem kleinzelligem Lungenkarzinom (ESCLC).

Methoden

Zwischen April 2005 und Mai 2014 wurden 204 Patienten mit ESCLC nach Ansprechen auf eine initiale Chemotherapie (gemäß RECIST 1.1) untersucht. Vor der Chemotherapie wurden bei allen Patienten Untersuchungen mit entsprechenden Bildgebungsverfahren durchgeführt, um Metastasen im Gehirn auszuschließen. 45 Patienten (22,1 %) wurden anschließend mit PCI behandelt, die übrigen (77,9 %) erhielten keine Behandlung (Kontrollgruppe). Der primäre Endpunkt der Studie war das OS. Ebenfalls beurteilt wurden das Auftreten von Hirnmetastasen, das hirnmetastasenfreie Überleben (BMFS) und Nebenwirkungen.

Ergebnisse

Die Daten zum Überleben der 204 Patienten wurden statistisch ausgewertet. Die PCI verlängerte das mittlere OS im Vergleich zur Kontrollgruppe signifikant von 12,6 Monaten auf 16,5 Monate (Hazard Ratio [HR]: 0,63; 95 %-Konfidenzintervall [KI]: 0,41–0,96; p = 0,033). Das Risiko von Hirnmetastasen wurde signifikant verringert (HR: 0,48; 95 %-KI: 0,30–0,76; p = 0,001). Die 1‑Jahres-Inzidenz von Hirnmetastasen betrug dabei 17,1 % in der PCI- und 55,9 % in der Kontrollgruppe. Zudem konnte ein signifikanter Zusammenhang zwischen PCI und dem mittleren BMFS festgestellt werden (p = 0,002). Multivariate Analysen zeigten zusätzlich, dass die PCI ein günstiger, unabhängiger Prädiktor für OS, BMFS und die Inzidenz von Hirnmetastasen ist. Akute und chronische Nebenwirkungen waren gering und wurden gut von den mit PCI behandelten Patienten vertragen.

Schlussfolgerungen

Das OS der in dieser Studie untersuchten Patienten mit ESCLC nach Ansprechen auf eine initiale Chemotherapie konnte durch PCI signifikant verbessert werden.

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Acknowledgements

This work was jointly supported by the National Natural Science Foundation of China (11505012) and the Beijing Municipal Administration of Hospitals’ Youth Programme (QML20151004).

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Authors and Affiliations

  1. Medical Center Tsinghua University, Tsinghua University, Beijing, China

    Yi Chen

  2. Department of Medical Oncology, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, 100853, Beijing, China

    Jinyu Li, Yi Hu, Zhi Lin & Shunchang Jiao

  3. Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiotherapy, Peking University Cancer Hospital & Institute, Beijing, China

    Yibao Zhang

  4. Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China

    Zhifei Zhao

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  1. Yi Chen
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  2. Jinyu Li
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Corresponding author

Correspondence to Shunchang Jiao.

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Conflict of interest

Y. Chen, J. Li, Y. Hu, Y. Zhang, Z. Lin, Z. Zhao, and S. Jiao declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Yi Chen and Jinyu Li contributed equally to this work.

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Chen, Y., Li, J., Hu, Y. et al. Prophylactic cranial irradiation could improve overall survival in patients with extensive small cell lung cancer. Strahlenther Onkol 192, 905–912 (2016). https://doi.org/10.1007/s00066-016-1038-0

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  • DOI: https://doi.org/10.1007/s00066-016-1038-0

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