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Yao N, Qin Z, Chen M, Hu L, Ma J, Lu J, Tong S, Li N, Yao Y. Effects of brain radiotherapy strategies on survival in the era of MRI for patients with limited stage small cell lung cancer. BMC Cancer 2024; 24:953. [PMID: 39103758 DOI: 10.1186/s12885-024-12739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 07/31/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND AND PURPOSE In the context of the widespread availability of magnetic resonance imaging (MRI) and aggressive salvage irradiation techniques, there has been controversy surrounding the use of prophylactic cranial irradiation (PCI) for small-cell lung cancer (SCLC) patients. This study aimed to explore whether regular brain MRI plus salvage brain irradiation (SBI) is not inferior to PCI in patients with limited-stage SCLC (LS-SCLC). METHODS This real-world multicenter study, which was conducted between January 2014 and September 2020 at three general hospitals, involved patients with LS-SCLC who had a good response to initial chemoradiotherapy and no brain metastasis confirmed by MRI. Overall survival (OS) was compared between patients who did not receive PCI for various reasons but chose regular MRI surveillance and followed salvage brain irradiation (SBI) when brain metastasis was detected and patients who received PCI. RESULTS 120 patients met the inclusion criteria. 55 patients received regular brain MRI plus SBI (SBI group) and 65 patients received PCI (PCI group). There was no statistically significant difference in median OS between the two groups (27.14 versus 33.00 months; P = 0.18). In the SBI group, 32 patients underwent whole brain radiotherapy and 23 patients underwent whole brain radiotherapy + simultaneous integrated boost. On multivariate analysis, only extracranial metastasis was independently associated with poor OS in the SBI group. CONCLUSION The results of this real-world study showed that MRI surveillance plus SBI is not inferior to PCI in OS for LS-SCLC patients who had a good response to initial chemoradiotherapy.
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Affiliation(s)
- Nan Yao
- Department of Radiation Oncology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi, 214023, Jiangsu, China
- Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, Jiangsu, China
| | - Zhaohui Qin
- Research Center for Medical and Health Emergency Rescue, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Meng Chen
- Department of Radiation Oncology, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Lingling Hu
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Ji Ma
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Jiaying Lu
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Shaodong Tong
- Department of Radiation Oncology, The Third People's Hospital of Xuzhou, Xuzhou, 221005, Jiangsu, China
| | - Na Li
- Department of Radiation Oncology, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Yuanhu Yao
- Department of Radiation Oncology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi, 214023, Jiangsu, China.
- Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, Jiangsu, China.
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Pellerino A, Davidson TM, Bellur SS, Ahluwalia MS, Tawbi H, Rudà R, Soffietti R. Prevention of Brain Metastases: A New Frontier. Cancers (Basel) 2024; 16:2134. [PMID: 38893253 PMCID: PMC11171378 DOI: 10.3390/cancers16112134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/29/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
This review discusses the topic of prevention of brain metastases from the most frequent solid tumor types, i.e., lung cancer, breast cancer and melanoma. Within each tumor type, the risk of brain metastasis is related to disease status and molecular subtype (i.e., EGFR-mutant non-small cell lung cancer, HER2-positive and triple-negative breast cancer, BRAF and NRAF-mutant melanoma). Prophylactic cranial irradiation is the standard of care in patients in small cell lung cancer responsive to chemotherapy but at the price of late neurocognitive decline. More recently, several molecular agents with the capability to target molecular alterations driving tumor growth have proven as effective in the prevention of secondary relapse into the brain in clinical trials. This is the case for EGFR-mutant or ALK-rearranged non-small cell lung cancer inhibitors, tucatinib and trastuzumab-deruxtecan for HER2-positive breast cancer and BRAF inhibitors for melanoma. The need for screening with an MRI in asymptomatic patients at risk of brain metastases is emphasized.
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Affiliation(s)
- Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience ‘Rita Levi Montalcini’, University and City of Health and Science Hospital, 10126 Turin, Italy;
| | - Tara Marie Davidson
- Department of Melanoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX 77030, USA; (T.M.D.); (H.T.)
| | - Shreyas S. Bellur
- Department of Medical Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (S.S.B.); (M.S.A.)
| | - Manmeet S. Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (S.S.B.); (M.S.A.)
| | - Hussein Tawbi
- Department of Melanoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX 77030, USA; (T.M.D.); (H.T.)
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience ‘Rita Levi Montalcini’, University and City of Health and Science Hospital, 10126 Turin, Italy;
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Wu J, Zhou Y, Xu C, Yang C, Liu B, Zhao L, Song J, Wang W, Yang Y, Liu N. Effectiveness of CT radiomic features combined with clinical factors in predicting prognosis in patients with limited-stage small cell lung cancer. BMC Cancer 2024; 24:170. [PMID: 38310283 PMCID: PMC10838455 DOI: 10.1186/s12885-024-11862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/09/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND The prognosis of SCLC is poor and difficult to predict. The aim of this study was to explore whether a model based on radiomics and clinical features could predict the prognosis of patients with limited-stage small cell lung cancer (LS-SCLC). METHODS Simulated positioning CT images and clinical features were retrospectively collected from 200 patients with histological diagnosis of LS-SCLC admitted between 2013 and 2021, which were randomly divided into the training (n = 140) and testing (n = 60) groups. Radiomics features were extracted from simulated positioning CT images, and the t-test and the least absolute shrinkage and selection operator (LASSO) were used to screen radiomics features. We then constructed radiomic score (RadScore) based on the filtered radiomics features. Clinical factors were analyzed using the Kaplan-Meier method. The Cox proportional hazards model was used for further analyses of possible prognostic features and clinical factors to build three models including a radiomic model, a clinical model, and a combined model including clinical factors and RadScore. When a model has prognostic predictive value (AUC > 0.7) in both train and test groups, a nomogram will be created. The performance of three models was evaluated using area under the receiver operating characteristic curve (AUC) and Kaplan-Meier analysis. RESULTS A total of 1037 features were extracted from simulated positioning CT images which were contrast enhanced CT of the chest. The combined model showed the best prediction, with very poor AUC for the radiomic model and the clinical model. The combined model of OS included 4 clinical features and RadScore, with AUCs of 0.71 and 0.70 in the training and test groups. The combined model of PFS included 4 clinical features and RadScore, with AUCs of 0.72 and 0.71 in the training and test groups. T stages, ProGRP and smoke status were the independent variables for OS in the combined model, whereas T stages, ProGRP and prophylactic cranial irradiation (PCI) were the independent factors for PFS. There was a statistically significant difference between the low- and high-risk groups in the combined model of OS (training group, p < 0.0001; testing group, p = 0.0269) and PFS (training group, p < 0.0001; testing group, p < 0.0001). CONCLUSION Combined models involved RadScore and clinical factors can predict prognosis in LS-SCLC and show better performance than individual radiomics and clinical models.
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Affiliation(s)
- Jiehan Wu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
- Langfang Health Vocational College, Siguang Road, Guangyang District, Langfang, 065000, Hebei, China
| | - Yuntao Zhou
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Chang Xu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Chengwen Yang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Bingxin Liu
- College of Arts and Sciences, Lehigh University, 27 Memorial Drive West, Bethlehem, PA, 18015, USA
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Jiawei Song
- Department of Oncology, the People's Hospital of Ganyu District, Lianyungang, 222100, China
| | - Wei Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Yining Yang
- The Department of Radiotherapy, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Ningbo Liu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
- Hetian District People's Hospital, Hetian, 848000, Xinjiang, China.
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Cozzi S, Bruni A, Ruggieri MP, Borghetti P, Scotti V, Franceschini D, Fiore M, Taraborrelli M, Salvi F, Galaverni M, Savoldi L, Braglia L, Botti A, Finocchi Ghersi S, Niccolò GL, Lohr F, Iotti C, Ciammella P. Thoracic Radiotherapy in Extensive Disease Small Cell Lung Cancer: Multicenter Prospective Observational TRENDS Study. Cancers (Basel) 2023; 15:cancers15020434. [PMID: 36672383 PMCID: PMC9857193 DOI: 10.3390/cancers15020434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
(1) Introduction: Small cell lung cancer (SCLC) is an aggressive tumor type, accounting for about 15% of all lung cancers. Radiotherapy (RT) plays a fundamental role in both early and advanced stages. Currently, in advanced disease, the use of consolidative chest RT should be recommended for patients with good response to platinum-based first-line chemotherapy, but its use has not yet been standardized. The present prospective study aims to evaluate the pattern of care of consolidative chest RT in patients with advanced stage SCLC, and its effectiveness in terms of disease control and tolerability. (2) Materials and methods: This study was a multicenter prospective observational trial, proposed and conducted within the AIRO lung study group to evaluate the pattern of care of consolidative chest RT after first-line chemotherapy in patients with advanced SCLC. The patient and tumor characteristics, doses, fractionation and volumes of thoracic RT and prophylactic cranial irradiation (PCI), as well as the thoracic and extrathoracic response to the treatment, toxicity and clinical outcomes, were collected and analyzed. (3) Results: From January 2017 to December 2019, sixty-four patients were enrolled. Median follow-up was 33 months. The median age was 68 years (range 42-81); 38 patients (59%) were male and 26 (41%) female. Carboplatin + etoposide for 6 cycles was the most commonly used first-line therapeutic scheme (42%). With regard to consolidative chest RT, 56% of patients (35) received 30 Gy in 10 factions and 16 patients (26%) received 45 Gy in 15 sessions. The modulated intensity technique was used in 84.5% of cases, and post-chemotherapy macroscopic residual disease was the target volume in 87.5% of patients. Forty-four patients (69%) also underwent PCI. At the last follow-up, over 60% of patients did not experience chest disease progression, while 67% showed extrathoracic progression. At the first radiological evaluation after RT, complete response and stable disease were recorded in 6% and 46% of the cases, respectively. Two patients had a long-term complete response to the combined treatment. The brain was the first site of extrathoracic progression in 28%. 1y and 2y OS and PFS were 67%, 19%, 28% and 6%, respectively. Consolidative chest RT was well-tolerated in the majority of patients; it was interrupted in three cases (due to G2 pulmonary toxicity, disease progression and clinical decay, respectively). Only 1 patient developed G3 asthenia. (4) Conclusions: Consolidative chest RT has been shown to be useful in reducing the risk of thoracic disease progression and is absolutely well-tolerated in patients with advanced stage SCLC with good response after first-line chemotherapy. Among the Italian centers that participated in this study, there is still variability in the choice of fractionation and target volumes, although the guidelines contain clear recommendations. The aim of future research should be to clarify the role and modalities of chest RT in the era of immunotherapy in advanced-stage SCLC.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Radiation Oncology Department, Centre Lèon Bèrard, 693736 Lyon, France
- Correspondence:
| | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department AOU Careggi Firenze, 50134 Florence, Italy
| | | | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Maria Taraborrelli
- Radiation Oncology Unit, “SS Annunziata” Hospital, “G. D’Annunzio” University, 66100 Chieti, Italy
| | - Fabrizio Salvi
- Radiation Oncology Unit, Bellaria Hospital, 40139 Bologna, Italy
| | - Marco Galaverni
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126 Parma, Italy
| | - Luisa Savoldi
- Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Luca Braglia
- Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant’Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185 Rome, Italy
| | - Giaj-Levra Niccolò
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, 37024 Verona, Italy
| | - Frank Lohr
- Radiation Oncology Department, Centre Lèon Bèrard, 693736 Lyon, France
- Department of Medical and Surgical Science, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Hou Q, Sun B, Yao N, Liang Y, Cao X, Wei L, Cao J. Construction of Brain Metastasis Prediction Model and Optimization of Prophylactic Cranial Irradiation Selection for Limited-Stage Small-Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14194906. [PMID: 36230830 PMCID: PMC9563012 DOI: 10.3390/cancers14194906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/21/2022] Open
Abstract
Prophylactic cranial irradiation (PCI), as an essential part of the treatment of limited-stage small-cell lung cancer (LS-SCLC), inevitably leads to neurotoxicity. This study aimed to construct a brain metastasis prediction model and identify low-risk patients to avoid PCI; 236 patients with LS-SCLC were retrospectively analyzed and divided into PCI (63 cases) and non-PCI groups (173 cases). The nomogram was developed based on variables determined by univariate and multivariate analyses in the non-PCI group. According to the cutoff nomogram score, all patients were divided into high- and low-risk cohorts. A log-rank test was used to compare the incidence of brain metastasis between patients with and without PCI in the low-risk and high-risk groups, respectively. The nomogram included five variables: chemotherapy cycles (ChT cycles), time to radiotherapy (RT), lactate dehydrogenase (LDH), pro-gastrin-releasing peptide precursor (ProGRP), and lymphocytes−monocytes ratio (LMR). The area under the receiver operating characteristics (AUC) of the nomogram was 0.763 and 0.782 at 1 year, and 0.759 and 0.732 at 2 years in the training and validation cohorts, respectively. Based on the nomogram, patients were divided into high- and low-risk groups with a cutoff value of 165. In the high-risk cohort, the incidence of brain metastasis in the non-PCI group was significantly higher than in the PCI group (p < 0.001), but there was no difference in the low-risk cohort (p = 0.160). Propensity score-matching (PSM) analysis showed similar results; the proposed nomogram showed reliable performance in assessing the individualized brain metastasis risk and has the potential to become a clinical tool to individualize PCI treatment for LS-SCLC.
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Maragkoudakis E, Kouloulias V, Grenzelia M, Kougioumtzopoulou A, Zygogianni A, Ramfidis V, Charpidou A. Impact of Hippocampal Avoidance - Prophylactic Cranial Irradiation in Small Cell Lung Cancer Patients. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:279-284. [PMID: 35530654 PMCID: PMC9066538 DOI: 10.21873/cdp.10105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/14/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND/AIM Prophylactic cranial irradiation (PCI) is a well-established treatment of small cell lung cancer (SCLC) patients following response to initial chemoradiotherapy. The benefit of PCI does, however, come at the cost of cognitive decline. This has been attributed to radiation-induced toxicity at the hippocampus, a crucial anatomic area for cognition. Modern radiotherapy techniques allow dose reduction at the hippocampal region. In this review, the safety profile, effect on cognition, and changes on brain imaging modalities of hippocampal avoidance-PCI (HA-PCI) will be presented, aiming to identify a potential clinical rationale for SCLC patients. MATERIALS AND METHODS A systematic review of the literature was performed in Pubmed, Cochrane library databases and ClinicalTrials.gov with no past date limitations until 07/01/2022. Principles as outlined in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement were followed. RESULTS Eight studies published from 2015 to 2021 were included. CONCLUSION HA-PCI is safe, yet its effect on neurocognition and imaging remains unclear, as studies have shown contradictory results.
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Affiliation(s)
- Emmanouil Maragkoudakis
- National and Kapodistrian University of Athens, 2nd Radiology Department, Radiotherapy Unit, Attikon University Hospital, Athens, Greece
| | - Vasileios Kouloulias
- National and Kapodistrian University of Athens, 2nd Radiology Department, Radiotherapy Unit, Attikon University Hospital, Athens, Greece
| | - Maria Grenzelia
- National and Kapodistrian University of Athens, 1st Radiology Department, Radiotherapy Unit, Aretaieion University Hospital, Athens, Greece
| | - Andromachi Kougioumtzopoulou
- National and Kapodistrian University of Athens, 2nd Radiology Department, Radiotherapy Unit, Attikon University Hospital, Athens, Greece
| | - Anna Zygogianni
- National and Kapodistrian University of Athens, 1st Radiology Department, Radiotherapy Unit, Aretaieion University Hospital, Athens, Greece
| | - Vasileios Ramfidis
- School of Medicine, National & Kapodistrian University, 3rd Department of Medicine, Sotiria General Hospital, Athens, Greece
| | - Andrianni Charpidou
- School of Medicine, National & Kapodistrian University, 3rd Department of Medicine, Sotiria General Hospital, Athens, Greece
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Tomassen ML, Pomp J, van der Stap J, van Lindert AS, Peters M, Belderbos JS, De Ruysscher DK, Lin SH, Verhoeff JJ, van Rossum PS. The overall survival impact of prophylactic cranial irradiation in limited-stage small-cell lung cancer: a systematic review and meta-analysis. Clin Transl Radiat Oncol 2022; 33:145-152. [PMID: 35243025 PMCID: PMC8881197 DOI: 10.1016/j.ctro.2022.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 12/25/2022] Open
Abstract
PCI for LS-SCLC patients has become more controversial. Literature search on PCI impact on overall survival in LS-SCLC yielded 28 studies. Meta-analysis of adjusted HRs revealed pooled HR of 0.62 (95% CI: 0.57–0.69). Findings support PCI in current practice while awaiting prospective trial results.
Background Prophylactic cranial irradiation (PCI) for limited-stage small-cell lung cancer (LS-SCLC) patients has become more controversial. Since the publication of the systematic review by Aupérin et al. in 1999, no randomized controlled trials regarding PCI in LS-SCLC have been completed. The aim of this study was to systematically review and meta-analyze the effect of PCI on overall survival (OS) in patients with LS-SCLC. Methods A systematic search was conducted in the databases of MEDLINE (PubMed), Embase and the Cochrane library. Only studies that reported an adjusted hazard ratio (aHR), indicating the effect of PCI versus no PCI on OS (adjusted for confounders) in patients with LS-SCLC were included for critical appraisal and meta-analysis. A pooled aHR estimate was calculated using a random-effects model. Results Pooling of 28 retrospective studies including a total of 18,575 patients demonstrated a significant beneficial effect of PCI versus no PCI on OS with a pooled aHR of 0.62 (95% CI: 0.57–0.69). Substantial heterogeneity of reported aHRs among studies was observed (I2 = 65.9%). Subgroup analyses revealed that this heterogeneity could partly be explained by study sample size. The pooled aHR among 7 versus 21 studies with a sample size of > 300 versus ≤ 300 patients was 0.79 (95% CI: 0.64–0.97) versus 0.56 (95% CI: 0.46–0.69; p < 0.001), respectively. Conclusions This meta-analysis demonstrates a significant beneficial effect of PCI on OS in patients with LS-SCLC. Larger studies reported a milder beneficial effect, possibly due to a decreased risk of model overfitting. Serious risk of selection and confounding bias were of concern due to the lack of prospective trials. These results support the role of PCI in standard clinical practice in patients with LS-SCLC while awaiting results of prospective trials on alternative strategies.
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Affiliation(s)
- Mathijs L. Tomassen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jacquelien Pomp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - José S.A. Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute – Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Dirk K.M. De Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Steven H. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston (TX), United States of America
| | - Joost J.C. Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter S.N. van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
- Corresponding author.
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Hiddinga BI, Raskin J, Janssens A, Pauwels P, Van Meerbeeck JP. Recent developments in the treatment of small cell lung cancer. Eur Respir Rev 2021; 30:210079. [PMID: 34261744 PMCID: PMC9488550 DOI: 10.1183/16000617.0079-2021] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/27/2021] [Indexed: 12/19/2022] Open
Abstract
Small cell lung cancer (SCLC) comprises about 15% of all lung cancers. It is an aggressive disease, with early metastasis and a poor prognosis. Until recently, SCLC treatment remained relatively unchanged, with chemotherapy remaining the cornerstone of treatment. In this overview we will highlight the recent advances in the field of staging, surgery, radiotherapy and systemic treatment. Nevertheless, the prognosis remains dismal and there is a pressing need for new treatment options. We describe the progress that has been made in systemic treatment by repurposing existing drugs and the addition of targeted treatment. In recent years, immunotherapy entered the clinic with high expectations of its role in the treatment of SCLC. Unravelling of the genomic sequence revealed new possible targets that may act as biomarkers in future treatment of patients with SCLC. Hopefully, in the near future, we will be able to identify patients who may benefit from targeted therapy or immunotherapy to improve prognoses.
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Affiliation(s)
- Birgitta I Hiddinga
- Dept of Pulmonary Medicine and Tuberculosis, University Medical Centre Groningen, Groningen, The Netherlands
- Both authors contributed equally
| | - Jo Raskin
- Dept of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
- Both authors contributed equally
| | - Annelies Janssens
- Dept of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Antwerp, Belgium
| | - Patrick Pauwels
- University of Antwerp, Antwerp, Belgium
- Dept of Pathology, Antwerp University Hospital, Edegem, Belgium
- European Reference Network for rare and low prevalent lung diseases (ERN-LUNG), Frankfurt am Main, Germany
| | - Jan P Van Meerbeeck
- Dept of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Antwerp, Belgium
- European Reference Network for rare and low prevalent lung diseases (ERN-LUNG), Frankfurt am Main, Germany
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9
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Ghanta S, Keller A, Rodríguez-López JL, Patel A, Beriwal S. Utility of Prophylactic Cranial Irradiation for Limited Stage Small Cell Lung Cancer in the Modern Era with Magnetic Resonance Imaging Surveillance. Clin Oncol (R Coll Radiol) 2021; 33:e323-e330. [PMID: 33888381 DOI: 10.1016/j.clon.2021.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/03/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
AIMS To retrospectively analyse the impact of prophylactic cranial irradiation (PCI) on survival and intracranial progression in patients with limited stage small cell lung cancer (LS-SCLC) in the modern era of widespread magnetic resonance imaging brain screening. MATERIALS AND METHODS Patients with LS-SCLC treated within our network between 2009 and 2020 who responded to initial therapy were stratified by receipt of PCI and stage of disease. A propensity score match analysis was carried out for stage II-III patients. Overall and neurological survival were defined as time to death and presumed death due to uncontrolled intracranial disease, respectively. Brain metastasis-free survival and symptomatic brain metastasis-free survival were defined as freedom from intracranial progression and symptomatic intracranial progression, respectively. The effect of PCI on these outcomes was assessed using Kaplan-Meier and Cox proportional hazards models. RESULTS In total, 243 (69.6%) of 349 patients received PCI. On multivariate analysis in the propensity matched stage II-III cohort, PCI was a significant predictor of improved neurological survival (hazard ratio 0.23, 95% confidence interval 0.08-0.65; P = 0.01), brain metastasis-free survival (hazard ratio 0.25, 95% confidence interval 0.12-0.51; P < 0.01) and symptomatic brain metastasis-free survival (hazard ratio 0.21, 95% confidence interval 0.08-0.55; P < 0.01), but not improved overall survival. Two-year neurological survival estimates within the propensity matched cohort were 96.8% (95% confidence interval 87.6-99.2%) with PCI and 77.2% (95% confidence interval 63.0-86.4%) without PCI and 1- and 2-year estimates of incidence of brain metastases were 3.9% (95% confidence interval 1.3-11.7%) and 11.7% (95% confidence interval 5.6-23.5%) in the PCI group and 31.6% (95% confidence interval 22.1-43.9%) and 40.4% (95% confidence interval 29.2-54.0%) in the no PCI group, respectively. CONCLUSIONS In the modern era of magnetic resonance imaging screening, PCI was associated with reduced incidence of intracranial progression in patients with stage II-III LS-SCLC who respond to initial therapy. This, importantly, translated to a decreased risk of neurological death within our propensity matched cohort, without significant improvement in overall survival.
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Affiliation(s)
- S Ghanta
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - A Keller
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - J L Rodríguez-López
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - A Patel
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - S Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.
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Prophylactic cranial irradiation in patients with small cell lung cancer in The Netherlands: A population-based study. Clin Transl Radiat Oncol 2021; 27:157-163. [PMID: 33665386 PMCID: PMC7903055 DOI: 10.1016/j.ctro.2021.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 02/05/2021] [Indexed: 01/26/2023] Open
Abstract
Prophylactic cranial irradiation (PCI) use declined in The Netherlands. Independent predictors for prescription of PCI were identified. An alarming increase of practice variation was observed. Alternative MRI surveillance is not strictly adhered to.
Introduction Controversy has arisen regarding the benefit of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC), particularly since the 2017 Takahashi trial publication that supports MRI surveillance in extensive-stage (ES-)SCLC. The primary aim of this study was to assess trends and determinants in PCI use over the years 2010–2018. A secondary aim was to determine contemporary practice considerations among radiation oncologists (ROs). Methods A nationwide population-based cohort study was conducted using the Netherlands Cancer Registry data on all newly diagnosed SCLC patients (2010–2018). The change in PCI frequency over the years and determinants for PCI were analyzed using logistic regression models. Second, an online survey was performed among Dutch lung cancer ROs in 2020. Results Among 10,264 eligible patients, 4,894 (47%) received PCI. Compared to 2010–2014, PCI use significantly decreased in 2017–2018 in ES-SCLC (OR 0.68, 95%CI 0.60–0.77) and LS-SCLC (OR 0.56, 95%CI 0.47–0.67). Incidence year, age, performance status, and thoracic radiotherapy were independent determinants for PCI. Among 41 survey participants, PCI was recommended always/sometimes/never by 22%/71%/7% in ES-SCLC and 54%/44%/2% in LS-SCLC. For ES-SCLC and LS-SCLC, 63% and 25% of ROs, respectively, confirmed influence of the Takahashi trial on PCI recommendations. Denial of such influence was associated with insufficient institutional MRI capacity. Conclusions A significant declining trend of PCI use in both ES-SCLC and LS-SCLC was observed in The Netherlands since 2017. The Takahashi trial seems an explanation for this trend even in LS-SCLC, with differential influence of the trial depending on institutional MRI capacity. An alarming increase in practice variation regarding PCI was found which stresses the importance of ongoing trials.
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11
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Ding C, Li J, Wang S, Yang C, Zhang R, Bai W, Liu M, Zhen C, Qiao X. Prognostic factors for patients with limited-stage small-cell lung cancer without receiving prophylactic cranial irradiation. RADIATION MEDICINE AND PROTECTION 2020. [DOI: 10.1016/j.radmp.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Simone CB, Bogart JA, Cabrera AR, Daly ME, DeNunzio NJ, Detterbeck F, Faivre-Finn C, Gatschet N, Gore E, Jabbour SK, Kruser TJ, Schneider BJ, Slotman B, Turrisi A, Wu AJ, Zeng J, Rosenzweig KE. Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2020; 10:158-173. [PMID: 32222430 PMCID: PMC10915746 DOI: 10.1016/j.prro.2020.02.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Several sentinel phase III randomized trials have recently been published challenging traditional radiation therapy (RT) practices for small cell lung cancer (SCLC). This American Society for Radiation Oncology guideline reviews the evidence for thoracic RT and prophylactic cranial irradiation (PCI) for both limited-stage (LS) and extensive-stage (ES) SCLC. METHODS The American Society for Radiation Oncology convened a task force to address 4 key questions focused on indications, dose fractionation, techniques and timing of thoracic RT for LS-SCLC, the role of stereotactic body radiation therapy (SBRT) compared with conventional RT in stage I or II node negative SCLC, PCI for LS-SCLC and ES-SCLC, and thoracic consolidation for ES-SCLC. Recommendations were based on a systematic literature review and created using a consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS The task force strongly recommends definitive thoracic RT administered once or twice daily early in the course of treatment for LS-SCLC. Adjuvant RT is conditionally recommended in surgically resected patients with positive margins or nodal metastases. Involved field RT delivered using conformal advanced treatment modalities to postchemotherapy volumes is also strongly recommended. For patients with stage I or II node negative disease, SBRT or conventional fractionation is strongly recommended, and chemotherapy should be delivered before or after SBRT. In LS-SCLC, PCI is strongly recommended for stage II or III patients who responded to chemoradiation, conditionally not recommended for stage I patients, and should be a shared decision for patients at higher risk of neurocognitive toxicities. In ES-SCLC, radiation oncologist consultation for consideration of PCI versus magnetic resonance surveillance is strongly recommended. Lastly, the use of thoracic RT is strongly recommended in select patients with ES-SCLC after chemotherapy treatment, including a conditional recommendation in those responding to chemotherapy and immunotherapy. CONCLUSIONS RT plays a vital role in both LS-SCLC and ES-SCLC. These guidelines inform best clinical practices for local therapy in SCLC.
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Affiliation(s)
| | - Jeffrey A Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
| | - Alvin R Cabrera
- Department of Radiation Oncology, Kaiser Permanente, Seattle, WA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis, Sacramento, CA
| | - Nicholas J DeNunzio
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT
| | - Corinne Faivre-Finn
- Division of Cancer Science, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Elizabeth Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers University, New Brunswick, NJ
| | - Tim J Kruser
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL
| | - Bryan J Schneider
- Department of Medical Oncology, University of Michigan, Ann Arbor, MI
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Andrew Turrisi
- Department of Radiation Oncology, James H. Quillen VA Medical Center, Mountain Home, TN
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington, Seattle, WA
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Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy and carries a poor prognosis with limited effective treatments in the advanced setting. SCLC is characterized by a high tumor mutation burden and alterations in Notch signaling and DNA damage repair pathways, providing rationale for the use of immunotherapy and targeted therapies. Immunotherapies have led to the most significant advances in treating SCLC in decades, and several promising targeted approaches have emerged from the increased understanding of the biology of SCLC. However, responses to these novel approaches are far from universal, and efforts to refine these therapies are ongoing.
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14
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Chu X, Li S, Xia B, Chu L, Yang X, Ni J, Zou L, Li Y, Xie C, Lin J, Zhu Z. Patterns of brain metastasis immediately before prophylactic cranial irradiation (PCI): implications for PCI optimization in limited-stage small cell lung cancer. Radiat Oncol 2019; 14:171. [PMID: 31533763 PMCID: PMC6749639 DOI: 10.1186/s13014-019-1371-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background Prophylactic cranial irradiation (PCI) is indicated for limited-stage small cell lung cancer (LS-SCLC) with good response to chemoradiotherapy (CRT). However, brain metastasis (BM) developed in LS-SCLC before PCI is not rare. In this study, we comprehensively investigated the features of pre-PCI BMs, aiming to explore the potential of PCI optimization for LS-SCLC. Methods One-hundred-ten LS-SCLC patients achieving clinical complete remission after definitive CRT with contrast-enhanced cranial magnetic resonance imaging (MRI) at baseline and immediately before PCI were included. The time trend and risk factors for pre-PCI BM were evaluated. Several radiological features, including numbers, sizes, and locations of pre-PCI BMs, were investigated to explore the technical feasibility of stereotactic radiotherapy and hippocampal-avoidance (HA) PCI. Results Twenty-four (21.8%) of the LS-SCLC patients harbored pre-PCI BM, all except one were asymptomatic. CRT duration (CRT-D) was the only independent risk factor for pre-PCI BM. The pre-PCI BM rate gradually increased in line with a growing time interval between treatment initiation and pre-PCI MRI. Pre-PCI BM and prolonged CRT-D were both correlated with worse overall survival. Of 129 pre-PCI intracranial lesions, 2 (1.5%) were in the HA region. Eight of the 24 (33.3%) pre-PCI BM patients were ineligible for stereotactic radiotherapy. Conclusion Our findings suggest that PCI is still of importance in LS-SCLC, and MRI evaluation before PCI is indispensable. Investigations are warranted to explore the possibility of moving PCI up to before CRT completion in LS-SCLC patients with prolonged CRT-D. HA-PCI could be considered to reduce neurotoxicity. Electronic supplementary material The online version of this article (10.1186/s13014-019-1371-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shuyan Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Bingqing Xia
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Li Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Liqing Zou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yida Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Congying Xie
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Jie Lin
- Department of Medical Oncology, the Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China.
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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MicroRNA-330-3p promotes brain metastasis and epithelial-mesenchymal transition via GRIA3 in non-small cell lung cancer. Aging (Albany NY) 2019; 11:6734-6761. [PMID: 31498117 PMCID: PMC6756898 DOI: 10.18632/aging.102201] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 08/12/2019] [Indexed: 12/20/2022]
Abstract
Brain metastasis (BM) is associated with poor prognosis in patients with non-small cell lung cancer (NSCLC). We sought to identify microRNAs (miRNAs) that could serve as biomarkers to differentiate NSCLC patients with and without BM. Logistic regression was conducted with 122 NSCLC patients (60 without BM, 62 with BM) to assess the association between miRNAs and BM. We confirmed several risk factors for BM and revealed that serum miR-330-3p levels are higher in NSCLC patients with BM than that without BM. Overexpression of miR-330-3p promoted proliferation, migration, invasion and epithelial-mesenchymal transition (EMT) of NSCLC cells in vitro and NSCLC tumorigenesis in vivo. Knocking down miR-330-3p suppressed this metastatic phenotype. We identified putative miR-330-3p target genes by comparing mRNA microarray analysis data from A549 cells after miR-330-3p knockdown with candidate miR-330-3p target genes predicted by public bioinformatic tools and luciferase reporter assays. We found that GRIA3 is a target of miR-330-3p and that miR-330-3p stimulates EMT progress by mediating GRIA3-TGF-β1 interaction. Our results provide novel insight into the role of miR-330-3p in NSCLC metastasis, and suggest miR-330-3p may be a useful biomarker for identifying NSCLC with metastatic potential.
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Yin X, Yan D, Qiu M, Huang L, Yan SX. Prophylactic cranial irradiation in small cell lung cancer: a systematic review and meta-analysis. BMC Cancer 2019; 19:95. [PMID: 30665432 PMCID: PMC6341615 DOI: 10.1186/s12885-018-5251-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/26/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The efficacy of prophylactic cranial irradiation (PCI) in treating patients with small cell lung cancer (SCLC) has not been clear, and recent randomized studies have demonstrated conflicting results from previously published findings. The purpose of this study was to reevaluate the efficacy of PCI in patients with SCLC and to assess factors associated with its efficacy. METHODS We conducted a quantitative meta-analysis to explore the efficacy of PCI in patients with SCLC. A literature search was performed using EMBASE, MEDLINE, Cochrane and ClinicalTrials.gov databases. We pooled the data and compared overall survival (OS) and brain metastasis (BM) between patients treated with PCI (PCI group) and patients without PCI treatment (observation group). RESULTS Of the 1074 studies identified in our analysis, we selected seven studies including 2114 patients for the current meta-analysis. Our results showed that the PCI group showed decreased BM (HR = 0.45, 95% CI: 0.38-0.55, P < 0.001) and prolonged OS (HR = 0.81, 95% CI: 0.67-0.99, P < 0.001). However, in terms of OS, the pooled analysis showed a high heterogeneity (I2 = 74.1%, P = 0.001). In subgroup analyses of OS, we found that the heterogeneity mainly came from patients with brain imaging after initial chemoradiotherapy (HR = 0.94, 95% CI: 0.74-1.18, P = 0.59). CONCLUSIONS The results of this study showed that PCI has a significant effect on decreasing BM but little benefit in prolonging OS when brain imaging was introduced to confirm lack of BM after initial chemoradiotherapy and before irradiation.
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Affiliation(s)
- Xin Yin
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Danfang Yan
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Miao Qiu
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Liming Huang
- The First Department of Chemotherapy, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China
| | - Sen-Xiang Yan
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang, 310003, People's Republic of China.
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17
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Kou P, Wang H, Yang D, Zhang Y, Yu J. Application of prophylactic cranial irradiation in limited-stage small-cell lung cancer: which patients could benefit? Future Oncol 2019; 15:3237-3245. [PMID: 30091368 DOI: 10.2217/fon-2018-0481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Aim: To analyze the role of prophylactic cranial irradiation (PCI) on the survival for patients with limited-stage small-cell lung cancer (LS-SCLC). Patients & methods: We screened patients from SEER database. Kaplan–Meier analysis and Cox proportional hazard model were used to evaluate factors influencing survival. Results: LS-SCLC patients who receiving PCI were associated with better overall survival (OS; p < 0.001) and cancer-specific survival (CSS; p < 0.001). Multivariable Cox analysis revealed PCI was an independent prognostic factor for OS (p < 0.001) and CSS (p < 0.001). In subgroup analysis, there were no OS and CSS differences between PCI and no PCI groups in black patients and patient with a tumor size <5 cm (all p > 0.05). Conclusion: PCI remains an effective method for most LS-SCLC patients. However, caution should be taken in recommending PCI for black patients and patients with a tumor size <5 cm. Further clinical trials are necessary to validate our results and identify the most suitable patients for PCI in the modern era.
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Affiliation(s)
- Peisi Kou
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Haiyong Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital & Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, PR China
| | - Daoke Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Yan Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, PR China
| | - Jinming Yu
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Chen MY, Hu X, Xu YJ, Chen M. The impact of prophylactic cranial irradiation for post-operative patients with limited stage small cell lung cancer. Medicine (Baltimore) 2018; 97:e13029. [PMID: 30383664 PMCID: PMC6221751 DOI: 10.1097/md.0000000000013029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/05/2018] [Indexed: 11/26/2022] Open
Abstract
To evaluate the impact of prophylactic cranial irradiation (PCI) on the prognosis of patients who received definitive surgery for surgically resected small cell lung cancer (SCLC).A retrospective analysis was performed on post-operative SCLC patients treated in Zhejiang Cancer Hospital from January 2003 to December 2015. According to the treatment modality, patients were allocated to PCI group and non-PCI group. Univariate survival analysis was performed by the Kaplan-Meier method. Multivariate survival analysis was performed by a Cox proportional hazards model.A total of 52 patients were included for analysis, among which, 19 patients were in PCI group and 33 were in non-PCI group. Multivariate analysis revealed that PCI (HR = .330; P = .041) was an independently favorable prognostic factor for the overall survival. The median overall survival (OS) time was 32.9 months in PCI group, and 20.4 months in non-PCI group. The 2-year OS rates were 78.0% and 38.0% in PCI and non-PCI group respectively (P = .023). The brain metastasis-free survival (BMFS) rate at 2-year in PCI group was significantly higher than those of non-PCI group (89.0% vs 53.0%, respectively, P = .026).In conclusion, PCI might be suggested for limited SCLC patients who received definitive surgery.
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Affiliation(s)
- Meng-yuan Chen
- Department of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou
- Zhejiang Chinese Medicinal University, Hangzhou, Zhejiang Province, China
| | - Xiao Hu
- Department of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou
| | - Yu-jin Xu
- Department of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou
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Zhang C, He LJ, Ye HZ, Liu DF, Zhu YB, Miao DD, Zhang SP, Chen YY, Jia YW, Shen J, Liu XP. Nrf2 is a key factor in the reversal effect of curcumin on multidrug resistance in the HCT‑8/5‑Fu human colorectal cancer cell line. Mol Med Rep 2018; 18:5409-5416. [PMID: 30365132 PMCID: PMC6236280 DOI: 10.3892/mmr.2018.9589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023] Open
Abstract
Multidrug resistance (MDR) is a major concern when using chemotherapy for the treatment of patients with colorectal cancer. MDR modulators are agents that can reverse MDR and, thus, enhance the chemosensitivity of tumor cells. The development of MDR modulators can improve the therapeutic efficacies of MDR in cancer. However, few effective MDR modulators have been identified so far. Curcumin has been reported to be an effective compound in the reversal of MDR in colorectal cancer cells. However, the mechanisms associated with the reversal effect of curcumin on MDR and its regulation of target factors in MDR cells remain to be fully elucidated. 3-(4,5-dimethyl-2-thiazol)-2,5-diphenyltetrazolium bromide assays, flow cytometer apoptosis assays as well as mRNA and protein expression assays were performed in the present study, and the results confirmed the reversal effect of curcumin on HCT-8/5-Fu cells and provided evidence that activated nuclear factor erythroid 2-related factor (Nrf2) deficiency induced by the curcumin altered the B-cell lymphoma 2 (Bcl-2) associated X protein/Bcl-2 expression ratio, which led to the induction of apoptosis in HCT-8/5-Fu cells. These results indicated that Nrf2 may have a functional in the reversal effect of curcumin and contribute, at least in part, to the outcomes of chemotherapy in patients with MDR.
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Affiliation(s)
- Chao Zhang
- Center of Drug Screening and Evaluation, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Lian-Jun He
- School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Hai-Zhu Ye
- School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Ding-Feng Liu
- School of Pharmacy, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Yi-Bao Zhu
- School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Dong-Dong Miao
- School of Pharmacy, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Sheng-Peng Zhang
- Center of Drug Screening and Evaluation, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Yun-Yu Chen
- Center of Drug Screening and Evaluation, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Yuan-Wei Jia
- Center of Drug Screening and Evaluation, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Jie Shen
- Center of Drug Screening and Evaluation, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
| | - Xiao-Ping Liu
- Center of Drug Screening and Evaluation, Wannan Medical College, Wuhu, Anhui 241000, P.R. China
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Risk factors for brain metastasis in patients with small cell lung cancer without prophylactic cranial irradiation. Strahlenther Onkol 2018; 194:1152-1162. [DOI: 10.1007/s00066-018-1362-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/20/2018] [Indexed: 11/25/2022]
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Nakahara Y, Sasaki J, Fukui T, Otani S, Igawa S, Hayakawa K, Masuda N. The role of prophylactic cranial irradiation for patients with small-cell lung cancer. Jpn J Clin Oncol 2018; 48:26-30. [PMID: 29077861 DOI: 10.1093/jjco/hyx146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Abstract
Small-cell lung cancer (SCLC) has a particular propensity to metastasize to the brain, affecting ~10% of SCLC patients at diagnosis, but may occur in more than 50% of 2-year survivors. Most cytotoxic drugs have limited ability to cross the blood-brain barrier, and the effectiveness of chemotherapy for brain metastasis is limited. Therefore, prophylactic cranial irradiation (PCI) has been proposed to treat SCLC. A meta-analysis revealed that PCI significantly decreased the risk of brain metastasis and increased the 3-year survival rate; it has been established as a standard therapy for limited-disease SCLC. However, certain aspects of PCI remain unclarified, including the roles in resected SCLC and extensive-disease SCLC, and its neurotoxicities. In addition, information on PCI has been obtained from old clinical trials without the use of new imaging devices, such as magnetic resonance imaging. Evidence from advanced imaging techniques is needed in this era.
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Affiliation(s)
- Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine
| | - Sakiko Otani
- Department of Respiratory Medicine, Kitasato University School of Medicine
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Noriyuki Masuda
- Department of Respiratory Medicine, Kitasato University School of Medicine
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22
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Rossi A, Tay R, Chiramel J, Prelaj A, Califano R. Current and future therapeutic approaches for the treatment of small cell lung cancer. Expert Rev Anticancer Ther 2018; 18:473-486. [PMID: 29544351 DOI: 10.1080/14737140.2018.1453361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Small-cell lung cancer (SCLC) is a very aggressive disease characterized by a high response rate to first-line chemotherapy, but most patients relapse within 1 year with disappointing results to second-line treatments. Chemotherapy has reached a plateau of effectiveness and new therapeutic strategies are needed to change the natural history of SCLC. Areas covered: This review will focus on the current results and the future development of the therapeutic approaches for the treatment of SCLC. Expert commentary: Immunotherapy is becoming a new frontier for the management of SCLC with preliminary interesting results. To date, no targeted drugs have been approved for clinical practice but several novel agents are in an advanced stage of clinical development in SCLC.
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Affiliation(s)
- Antonio Rossi
- a Division of Medical Oncology , Scientific Institute for Research and Health Care (IRCCS) "Casa Sollievo della Sofferenza" , San Giovanni Rotondo , Italy
| | - Rebecca Tay
- b Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK
| | - Jaseela Chiramel
- b Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK
| | - Arsela Prelaj
- b Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK.,c Department of Radiological , Pathological and Oncological Science, Sapienza University of Rome , Italy
| | - Raffaele Califano
- b Department of Medical Oncology , The Christie NHS Foundation Trust , Manchester , UK.,d Department of Medical Oncology , Manchester University NHS Foundation Trust , Manchester , UK.,e Division of Cancer Sciences , University of Manchester , Manchester , UK
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23
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Scotti V, Meattini I, Franzese C, Saieva C, Bertocci S, Meacci F, Furfaro I, Scartoni D, Cecchini S, Desideri I, Ferrari K, Bruni A, De Luca Cardillo C, Bastiani P, Agresti B, Mangoni M, Livi L, Biti G. Radiotherapy Timing in the Treatment of Limited-stage Small Cell Lung Cancer: The Impact of Thoracic and Brain Irradiation on Survival. TUMORI JOURNAL 2018. [DOI: 10.1177/1578.17206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vieri Scotti
- Department of Radiation Oncology, University of Florence, Florence
| | - Icro Meattini
- Department of Radiation Oncology, University of Florence, Florence
| | - Ciro Franzese
- Department of Radiation Oncology, University of Florence, Florence
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence
| | - Silvia Bertocci
- Department of Radiation Oncology, University of Florence, Florence
| | - Fiammetta Meacci
- Department of Radiation Oncology, University of Florence, Florence
| | - Ilaria Furfaro
- Department of Radiation Oncology, University of Florence, Florence
| | - Daniele Scartoni
- Department of Radiation Oncology, University of Florence, Florence
| | - Sara Cecchini
- Department of Radiation Oncology, University of Florence, Florence
| | - Isacco Desideri
- Department of Radiation Oncology, University of Florence, Florence
| | - Katia Ferrari
- II Pneumology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Alessio Bruni
- Department of Radiation Oncology, University of Modena, Modena
| | | | - Paolo Bastiani
- Department of RadiationOncology, Santa Maria Annunziata Hospital, Florence
| | | | - Monica Mangoni
- Department of Radiation Oncology, University of Florence, Florence
| | - Lorenzo Livi
- Radiotherapy Unit Santa Chiara, Univeristy of Florence, Florence, Italy
| | - Giampaolo Biti
- Department of Radiation Oncology, University of Florence, Florence
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24
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Farrell MJ, Yahya JB, Degnin C, Chen Y, Holland JM, Henderson MA, Jaboin JJ, Harkenrider MM, Thomas CR, Mitin T. Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer: Survey of US Radiation Oncologists on Current Practice Patterns. Clin Lung Cancer 2018; 19:371-376. [PMID: 29559208 DOI: 10.1016/j.cllc.2018.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (LS-SCLC) is considered the standard of care. Meta-analysis of 7 clinical trials indicates a survival benefit to PCI, but all of these trials were conducted in the pre-magnetic resonance imaging (MRI) era. Therefore, routine brain imaging with MRI before PCI-as recommended by National Comprehensive Cancer Network guidelines-is not directly supported by the evidence. Current US practice patterns for patients with LS-SCLC are unknown. MATERIALS AND METHODS We surveyed practicing US radiation oncologists via an institutional review board-approved online questionnaire. Questions covered demographic information and treatment recommendations for LS-SCLC. RESULTS We received 309 responses from US radiation oncologists. Ninety-eight percent recommended PCI for patients with LS-SCLC, 96% obtained brain MRI before PCI, 33% obtained serial brain imaging with MRI after PCI to detect new metastases, and 35% recommended memantine for patients undergoing PCI. Recommending memantine was associated with fewer years of practice (P < .001), fewer lung cancer patients treated per year (P = .045), and fewer LS-SCLC patients treated per year (P = .024). CONCLUSION Almost all responding radiation oncologists recommended PCI and pre-PCI brain MRI for LS-SCLC patients with disease responsive to initial therapy. Only a third of respondents followed these patients with serial brain MRI. Approximately one third provided memantine therapy to try to limit neurocognitive effects of PCI. Further research is warranted to determine the best treatment for patients with LS-SCLC. This survey can inform the development of future trials that depend on participation from radiation oncologists.
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Affiliation(s)
- Matthew J Farrell
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR.
| | - Jehan B Yahya
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Catherine Degnin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Yiyi Chen
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - John M Holland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Mark A Henderson
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
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25
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Yang Y, Zhang D, Zhou X, Bao W, Ji Y, Sheng L, Cheng L, Chen Y, Du X, Qiu G. Prophylactic cranial irradiation in resected small cell lung cancer: A systematic review with meta-analysis. J Cancer 2018; 9:433-439. [PMID: 29344290 PMCID: PMC5771351 DOI: 10.7150/jca.21465] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022] Open
Abstract
Background: The use of PCI in early operable patients with small cell lung cancer (SCLC) is still controversial. Therefore, we conducted a systematic review with meta-analysis to investigate the effects of PCI in resected SCLC patients. Methods: Relevant studies were identified from PubMed and EMBASE databases, the pooled hazard risks were obtained by the random-effects model. We also analyzed the brain metastasis (BM) risk in p-stage I patients without PCI. Results: Five retrospective studies were identified and a total of 1691 patients were included in our analysis, 315 of them received PCI. For all the resected patients, PCI was associated with improved overall survival (HR: 0.52, 95% CI: 0.33-0.82), and reduced brain metastasis risk (RR: 0.50, 95%CI: 0.32-0.78). However, with regard to p-stage I patients, no survival benefit was brought by PCI (HR: 0.87, 95% CI: 0.34-2.24). Moreover, the pooled analysis of 7 studies found that the 5-year brain metastasis risk was relatively low (12%, 95% CI: 8%-17%) for p-stage I patients without PCI. Conclusions: PCI might be associated with a favorable survival advantage and reduced BM risk in complete resected SCLC patients, except for p-stage I patients.
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Affiliation(s)
- Yang Yang
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Danhong Zhang
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Xia Zhou
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Wuan Bao
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Yonglin Ji
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Liming Sheng
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Lei Cheng
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Ying Chen
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Xianghui Du
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Guoqin Qiu
- Department of Radiation Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
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26
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Dayen C, Debieuvre D, Molinier O, Raffy O, Paganin F, Virally J, Larive S, Desurmont-Salasc B, Perrichon M, Martin F, Grivaux M. New insights into stage and prognosis in small cell lung cancer: an analysis of 968 cases. J Thorac Dis 2017; 9:5101-5111. [PMID: 29312716 DOI: 10.21037/jtd.2017.11.52] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The French College of General Hospital Respiratory Physicians conducted two studies that consecutively included all patients followed in participating general hospitals for primary small cell (SCLC) or non-small cell (NSCLC) lung cancer diagnosed in 2000 and 2010. These studies allow descriptive statistics and outcome assessment for SCLC and NSCLC separately and comparison over a 10-year period. Methods A standardised form was completed for each patient at inclusion. Then, vital status was collected. Results In 2000 and 2010, 948 (15.5% female) and 968 (23.3%) SCLC patients, mainly heavy active- or former-smoker seniors, participated in these studies. One-year survival rate was 35.8% for SCLC vs. 44.8% for NSCLC in 2010 and 33.1% for SCLC in 2000. In 2010, in reference to stage 0-IIB (4.1% of SCLCs), the hazard ratio was 0.92 [95% confidence interval (CI): 0.6-1.5; P=0.76], 1.8 (95% CI: 1.1-2.8; P=0.019), and 3.4 (95% CI: 2.2-5.3; P<0.001) for stage IIIA (10.2%), IIIB (14.5%), and IV (71.2%). Positron emission tomography (PET)-scan use, which has increased in 10 years, was frequent in patients with limited disease. Conclusions One-year survival in SCLC patients was poor in 2010 and dependent of SCLC stage. TNM classification reintroduction and new diagnostic techniques (e.g., PET-scan) should allow lung oncologists to tailor treatment based on disease stage at diagnosis.
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Affiliation(s)
- Charles Dayen
- Respiratory Medicine Department, Hôpital de Saint-Quentin, Saint-Quentin, France
| | - Didier Debieuvre
- Respiratory Medicine Department, Groupe Hospitalier de la Région Mulhouse Sud-Alsace, Hôpital Émile Muller, Mulhouse, France
| | - Olivier Molinier
- Respiratory Medicine Department, Hôpital du Mans, Le Mans, France
| | - Olivier Raffy
- Respiratory Medicine Department, Hôpital Louis Pasteur, Le Coudray, France
| | - Fabrice Paganin
- Respiratory Medicine Department, Hôpital Sud de La Réunion, Saint-Pierre, France
| | - Jérôme Virally
- Respiratory Medicine Department, Centre Hospitalier Intercommunal Robert Ballanger, Aulnay-sous-Bois, France
| | - Sébastien Larive
- Respiratory Medicine Department, Hôpital Les Chanaux, Mâcon, France
| | - Béatrice Desurmont-Salasc
- Respiratory Medicine Department, Centre Hospitalier Intercommunal de Frejus-Saint-Raphaël, Saint-Raphaël, France
| | - Marielle Perrichon
- Respiratory Medicine Department, Hôpital Fleyriat, Bourg-en-Bresse, France
| | - Francis Martin
- Pneumology and Sleep Disorders Department, Centre Hospitalier Intercommunal de Compiègne-Noyon, Compiègne cedex, France
| | - Michel Grivaux
- Respiratory Medicine Department, Hôpital de Meaux, Meaux, France
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27
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Damhuis RAM, Senan S, Belderbos JS. Usage of Prophylactic Cranial Irradiation in Elderly Patients With Small-cell Lung Cancer. Clin Lung Cancer 2017; 19:e263-e267. [PMID: 29208355 DOI: 10.1016/j.cllc.2017.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/22/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prophylactic cranial irradiation (PCI) reduces the risk of overt brain metastases in patients with small-cell lung cancer (SCLC) and is currently recommended in guidelines for both limited and extensive disease. Given the concerns about the greater frequency of neurologic side effects in elderly patients, we studied the association among age, PCI usage, and survival for SCLC patients in the Netherlands. PATIENTS AND METHODS Data from the Netherlands Cancer Registry for patients diagnosed with SCLC from 2009 to 2013 were queried. Separate analyses were performed for patients with stage I to III, treated with chemoradiotherapy (n = 1684) and patients with stage IV, treated with chemotherapy or chemoradiotherapy (n = 3481). Patients with brain metastasis at diagnosis were excluded. RESULTS For patients with stage I to III, the overall PCI usage rate was 74%, and the rate decreased with age, from 78% for patients aged 18 to 59 years to 66% for patients aged ≥ 80 years. For patients with stage IV, the overall PCI usage rate was 41% and decreased with age, from 46% for patients aged 18 to 59 years to 23% for patients aged ≥ 80 years. Gender and socioeconomic status did not affect the PCI rates. For patients aged < 70 years and treated with PCI, the median survival was 45, 24, and 12 months for stage I and II, III, and IV, respectively. For patients aged ≥ 70 years treated with PCI, the corresponding survival duration was 33, 17, and 10 months. CONCLUSION In the Dutch population, PCI usage rates were fairly high but were significantly lower for elderly patients.
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Affiliation(s)
- Ronald A M Damhuis
- Department of Research, Comprehensive Cancer Organization, Utrecht, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jose S Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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28
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Lok BH, Ma J, Foster A, Perez CA, Shi W, Zhang Z, Li BT, Rudin CM, Rimner A, Wu AJ. Factors influencing the utilization of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer. Adv Radiat Oncol 2017; 2:548-554. [PMID: 29204521 PMCID: PMC5707415 DOI: 10.1016/j.adro.2017.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose Brain metastases are common in patients with limited-stage small cell lung cancer (LS-SCLC) due to the inability of most chemotherapeutics to penetrate the blood–brain barrier. Prophylactic cranial irradiation (PCI) is therefore recommended for use in patients with a good response to concurrent chemoradiotherapy. However, PCI is not always delivered; therefore, we investigated the reasons for PCI omission in patients who underwent therapy with curative intent. Methods and materials We retrospectively reviewed all patients with LS-SCLC who were treated with curative intent at our institution. Overall survival and cumulative incidence of brain metastasis were estimated by the Kaplan-Meier method. The Pearson χ2 test and Mann-Whitney U test were used to examine factors associated with PCI use, and prognostic factors were analyzed with Cox proportional hazards modeling. Results We examined 208 patients who were treated for LS-SCLC at our institution. A total of 115 patients (55%) received PCI. The most common documented reason for PCI omission was patient refusal due to neurotoxicity concerns (38%). Physician assessment of being medically unfit (33%) and of advanced age (8%) were the second and third most common reasons, respectively. Karnofsky performance status and clinical American Joint Committee on Cancer stage but not PCI were significantly associated with overall survival. Only clinical stage remained an independent factor on multivariate analysis. Conclusions Approximately half of patients with LS-SCLC ultimately receive PCI, generally for guideline-recommended reasons. The most common reason for PCI omission was patient concerns regarding neurotoxicity. Efforts to decrease PCI neurotoxicity, including hippocampal-sparing radiation and memantine use, may increase the use of this survival-improving intervention in eligible patients with LS-SCLC.
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Affiliation(s)
- Benjamin H Lok
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer Ma
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amanda Foster
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carmen A Perez
- Department of Radiation Oncology, New York University Langone Medical Center, New York, New York
| | - Weiji Shi
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bob T Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles M Rudin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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29
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Shao W, Wang X, Liu D. [Recent Advances and Future Strategies for Small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017. [PMID: 28641701 PMCID: PMC5973356 DOI: 10.3779/j.issn.1009-3419.2017.06.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
小细胞肺癌是一种致死率较高的恶性肿瘤,现阶段的治疗方式有手术,化疗和放疗,但预后极差。近些年来涌现的靶向治疗和免疫治疗也都在进行着大量的临床试验,本文将对小细胞肺癌目前的治疗策略以及未来研究的方向进行综述。
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Affiliation(s)
- Weipeng Shao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Peking University Health Science Center (PUSHC),
Beijing 100029, China
| | - Xiaowei Wang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Peking University Health Science Center (PUSHC),
Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Peking University Health Science Center (PUSHC),
Beijing 100029, China
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30
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Péchoux CL, Sun A, Slotman BJ, De Ruysscher D, Belderbos J, Gore EM. Prophylactic cranial irradiation for patients with lung cancer. Lancet Oncol 2017; 17:e277-e293. [PMID: 27396646 DOI: 10.1016/s1470-2045(16)30065-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/20/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
The incidence of brain metastases in patients with lung cancer has increased as a result of improved local and systemic control and better diagnosis from advances in brain imaging. Because brain metastases are responsible for life-threatening symptoms and serious impairment of quality of life, resulting in shortened survival, prophylactic cranial irradiation has been proposed in both small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) to try to improve incidence of brain metastasis, survival, and eventually quality of life. Findings from randomised controlled trials and a meta-analysis have shown that prophylactic cranial irradiation not only reduces the incidence of brain metastases in patients with SCLC and with non-metastatic NSCLC, but also improves overall survival in patients with SCLC who respond to first-line treatment. Although prophylactic cranial irradiation is potentially associated with neurocognitive decline, this risk needs to be balanced against the potential benefit in terms of brain metastases incidence and survival. Several strategies to reduce neurotoxicity are being investigated.
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Affiliation(s)
- Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France.
| | - Alexander Sun
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Oncology, Experimental Radiation Oncology, KU Leuven, Leuven, Belgium
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Elizabeth M Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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31
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Zhang J, Fan M, Liu D, Zhao KL, Wu KL, Zhao WX, Zhu ZF, Fu XL. Hypo- or conventionally fractionated radiotherapy combined with chemotherapy in patients with limited stage small cell lung cancer. Radiat Oncol 2017; 12:51. [PMID: 28283034 PMCID: PMC5346226 DOI: 10.1186/s13014-017-0788-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Previous data from our institution showed that hypofractionated thoracic radiotherapy (HypoTRT) with concurrent etoposide/platinum chemotherapy yielded favorable survival in patients with limited-stage small cell lung cancer (LS-SCLC). The present study retrospectively compared the survival outcomes, failure patterns and toxicities between groups of LS-SCLC patients treated with conventionally fractionated thoracic radiotherapy (ConvTRT) or HypoTRT combined with chemotherapy. Methods Medical records of LS-SCLC patients between January 2010 and December 2013 at Fudan University Shanghai Cancer Center were retrospectively reviewed. All patients treated with chemotherapy and ConvTRT (2 Gy per fraction daily, DT ≥ 56 Gy) or HypoTRT (2.5 Gy per fraction daily, DT = 55 Gy) were eligible for analysis. Progression-free survival (PFS) and overall survival (OS) were generated for different populations using the Kaplan-Meier method and compared using the log-rank test. Comparisons of failure patterns and toxicity were analyzed using the χ2 test. Results A total of 170 patients treated with HypoTRT (n = 69) or ConvTRT (n = 101) were eligible for analysis. The median PFS and OS were 13.7 and 25.3 months, respectively, in the ConvTRT cohort, which was similar to the HypoTRT cohort (PFS 18.2 months, p = 0.991, and OS 27.2 months, p = 0.698), with a median follow-up of 30 months. Multivariate analysis revealed that PCI and TNM stage were prognostic factors for PFS and that PCI was prognostic for OS. The patterns of failure (stratified by local-regional recurrence, distant metastasis or both as first relapse) were similar between the dose cohorts (p = 0.693, p = 0.330, p = 0.572). Distant metastasis remained the main failure pattern. The brain was the most frequent remote failure site, followed by bone, liver and adrenal gland. PCI improved the 2-year survival rate from 46.1% to 70.0% and the 2-year PFS rate from 20.9% to 45.3%, respectively (p < 0.001). Grade ≥3 esophagitis and pneumonitis occurred in 9.9% and 11.9%, respectively, of the patients in the ConvTRT cohort and in 11.6% and 10.0%, respectively, of those in the HypoTRT cohort (p = 0.815). Conclusion This retrospective analysis demonstrated that HypoTRT or ConvTRT combined with etoposide/platinum chemotherapy yielded statistically similar survival, treatment failure outcomes, and toxicity profiles. PCI correlated with improved PFS and OS.
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Affiliation(s)
- Jing Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong an Road, Shanghai, 200032, China
| | - Min Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong an Road, Shanghai, 200032, China.
| | - Di Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong an Road, Shanghai, 200032, China
| | - Kuai-Le Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong an Road, Shanghai, 200032, China
| | - Kai-Liang Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong an Road, Shanghai, 200032, China
| | - Wei-Xin Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong an Road, Shanghai, 200032, China
| | - Zheng-Fei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong an Road, Shanghai, 200032, China
| | - Xiao-Long Fu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong an Road, Shanghai, 200032, China
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An C, Jing W, Zhang Y, Liu S, Wang H, Zhu K, Kong L, Guo H, Zhu H. Thoracic radiation therapy could give survival benefit to elderly patients with extensive-stage small-cell lung cancer. Future Oncol 2017; 13:1149-1158. [PMID: 28326834 DOI: 10.2217/fon-2016-0467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate the effect of thoracic radiation therapy (TRT) in elderly patients (aged ≥65 years) with extensive-stage small-cell lung cancer (ES-SCLC). PATIENTS & METHODS This study reviewed the records of 118 elderly patients with ES-SCLC (all with distant metastasis) through January 2006-December 2013. The patients were divided into either a chemotherapy (ChT)/TRT-combination group or a ChT-alone group. RESULTS The median survival time and 3-year overall survival rates in the ChT/TRT group were significantly higher than those in the ChT-alone group (17.0 vs 11.7 months; 18.1 vs 14.9%; p = 0.014). The 3-year overall survival rates in patients who received prophylactic cranial irradiation were also higher than the rates in patients who did not receive prophylactic cranial irradiation (18.1 vs 5.1%; p = 0.708). CONCLUSION TRT combined with ChT could provide a survival benefit to elderly patients with ES-SCLC.
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Affiliation(s)
- Changchun An
- School of Medicine & Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Wang Jing
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.,Department of Radiation Oncology, the First Affiliated Hospital to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yan Zhang
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Sujing Liu
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Affiliated Hospital Medical College of Qingdao University, Yuhuangding Rd. 20, Yantai, Shandong Province, China
| | - Haiyong Wang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Kunli Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Hongbo Guo
- Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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Qiu YF, Liu ZG, Yang WJ, Zhao Y, Tang J, Tang WZ, Jin Y, Li F, Zhong R, Wang H. Research progress in the treatment of small cell lung cancer. J Cancer 2017; 8:29-38. [PMID: 28123595 PMCID: PMC5264037 DOI: 10.7150/jca.16822] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/18/2016] [Indexed: 01/04/2023] Open
Abstract
Small cell lung cancer (SCLC) accounts for approximately 10-15% of all lung cancers. No significant improvement has been made for patients with SCLC in the past several decades. The main progresses were the thoracic radiation and prophylactic cranial irradiation (PCI) that improved the patient survival rate. For patients with limited disease and good performance status (PS), concurrent chemoradiotherapy (CCRT) followed by PCI should be considered. For extensive disease, the combination of etoposide and platinum-based chemotherapy remains the standard treatment and consolidative thoracic radiotherapy is beneficial for patients who have a significant respond to initial chemotherapy. However, the prognosis still remains poor. Recently, efforts have been focused on molecular targets and immunotherapy. But numerous molecular targets methods have failed to show a significant clinical benefit in patients with SCLC. It is anticipated that further development of research will depend on the on-going trials for molecular targeted therapy and immunotherapy which are promising and may improve the outcomes for SCLC in the next decade.
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Affiliation(s)
| | - Zhi-gang Liu
- ✉ Corresponding authors: Hui Wang, M.D., Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University; E-mail: Fax: 0731-88651999. Zhi-gang Liu, M.D., Ph.D., Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University. E-mail:
| | | | | | | | | | | | | | | | - Hui Wang
- Key Laboratory of Translational Radiation Oncology, Hunan Province. Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
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Choi M, Lee Y, Moon SH, Han JY, Kim HT, Lee JS. Effect of Accurate Staging Using Positron Emission Tomography on the Outcomes of Prophylactic Cranial Irradiation in Patients With Limited Stage Small-Cell Lung Cancer. Clin Lung Cancer 2017; 18:77-84. [DOI: 10.1016/j.cllc.2016.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/16/2016] [Accepted: 06/21/2016] [Indexed: 11/26/2022]
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王 大, 徐 利, 赵 路, 章 文, 庞 青, 刘 宁, 陈 曦, 陈 秀, 袁 智, 王 平. [Concurrent Chemoradiotherapy with Original Chemotherapy Regimens may not be Suitable for Patients Who Failed to Respond to Induction Chemotherapy
in Limited-stage Small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:871-878. [PMID: 27978874 PMCID: PMC5973452 DOI: 10.3779/j.issn.1009-3419.2016.12.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND The group of small cell lung cancer (SCLC) are usually highly sensitive to chemotherapy, and less than 15% of them are resistant to drugs. We respectively evaluate the correlation of the sequence and timing of radiotherapy with progression-free survival (PFS) and overall survival (OS) in patients with limited-stage SCLC (LS-SCLC), and to figure out whether concurrent chemoradiotherapy is superior to sequent chemoradiotherapy. METHODS Sixty-seven patients diagnosed with LS-SCLC from January 2009 to June 2014 failed to respond to induction chemotherapy. According to the sequence of therapy, they were divided into concurrent chemoradiotherapy group (n=32) and sequent chemoradiotherapy group (n=35). Ninety-four percent of the patients were diagnosed with stage III, and six percent were stage Ib-IIb. Twenty-five patients were treated with prophylactic cranial irradiation (PCI). The Kaplan-Meier method was used to calculate survival time and Log-rank test was used for between-group comparisons. Between-group comparison of categorical data was made by χ2 test. RESULTS In all patients, the 2-year OS, PFS and LC rates were 53.7%, 20.9% and 58.2%. The 2-year OS and PFS rates of concurrent chemoradiotherapy group and sequent chemoradiotherapy were 37.5% vs 54.3% (P=0.048) and 12.5% vs 28.6% (P=0.149). Hematologic toxicities were more common in concurrent group than sequent one (P=0.031), and no statistical difference was observed between the two groups in terms of grade 3 radiation esophagitis, pneumonitis and gastrointestinal reactions (9.4% vs 0, P=0.176; 12.5% vs 2.9%, P=0.318; 12.5% vs 2.9%, P=0.109). Patients treated with PCI have superior OS and PFS comparing with those not (56.0% vs 38.1%, P=0.029; 24% vs 19%, P=0.012). CONCLUSIONS Concurrent chemoradiotherapy with original chemotherapy regimens may not be suitable for patients who failed to respond to induction chemotherapy in LS-SCLC, and second-line regimens or radiotherapy alone can be used for them, but prospective trils with large sample are still needed to confirm that.
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Affiliation(s)
- 大权 王
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 利明 徐
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 路军 赵
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 文成 章
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 青松 庞
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 宁波 刘
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 曦 陈
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 秀丽 陈
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 智勇 袁
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - 平 王
- />300060 天津,天津医科大学肿瘤医院放疗科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
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Clinical Features of Brain Metastases in Small Cell Lung Cancer: an Implication for Hippocampal Sparing Whole Brain Radiation Therapy. Transl Oncol 2016; 10:54-58. [PMID: 27940373 PMCID: PMC5154961 DOI: 10.1016/j.tranon.2016.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE: To assess the clinical features and distribution of brain metastases (BMs) of small cell lung cancer (SCLC) in the hippocampal and perihippocampal region, with the purpose of exploring the viability of hippocampal-sparing whole-brain radiation therapy (HS-WBRT) on reducing neurocognitive deficits. METHODS: This was a retrospective analysis of the clinical characteristics and patterns of BMs in patients with SCLC. Associations between the clinical characteristics and hippocampal metastases (HMs)/perihippocampal metastases (PHMs) were evaluated in univariate and multivariate regression analyses. RESULTS: A total of 1594 brain metastatic lesions were identified in 180 patients. Thirty-two (17.8%) patients were diagnosed with BMs at the time of primary SCLC diagnosis. The median interval between diagnosis of primary SCLC and BMs was 9.3 months. There were 9 (5.0%) and 22 (12.2%) patients with HMs and PHMs (patients with BMs located in or within 5 mm around the hippocampus), respectively. In the univariate and multivariate analysis, the number of BMs was the risk factor for HMs and PHMs. Patients with BMs ≥ 5 had significantly higher risk of HMs (odds ratio [OR] 7.892, 95% confidence interval [CI] 1.469-42.404, P = .016), and patients with BMs ≥ 7 had significantly higher risk of PHMs (OR 5.162, 95% CI 2.017-13.213, P = .001). Patients with extracranial metastases are also associated with HMs. CONCLUSIONS: Our results indicate that patients with nonoligometastatic disease are significantly associated with HMs and PHMs. The incidence of PHMs may be acceptably low enough to perform HS-WBRT for SCLC. Our findings provide valuable clinical data to assess the benefit of HS-WBRT in SCLC patients with BMs.
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Eze C, Roengvoraphoj O, Niyazi M, Hildebrandt G, Fietkau R, Belka C, Manapov F. Treatment Response and Prophylactic Cranial Irradiation Are Prognostic Factors in a Real-life Limited-disease Small-cell Lung Cancer Patient Cohort Comprehensively Staged With Cranial Magnetic Resonance Imaging. Clin Lung Cancer 2016; 18:e243-e249. [PMID: 28065620 DOI: 10.1016/j.cllc.2016.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prophylactic cranial irradiation (PCI) has proven to decrease the incidence of brain metastases (BMs), with a modest improvement in survival. PATIENTS AND METHODS The impact of PCI was evaluated in 184 patients treated with chemoradiotherapy. PCI was applied to patients with disease with partial and complete response only when cranial magnetic resonance imaging before and after primary treatment revealed no BMs. Correlation between PCI and overall survival (OS), BM-free survival (BMFS), and time to progression (TTP) was analyzed to describe survival within subgroups. RESULTS Concurrent and sequential chemoradiotherapy was applied in 71 patients (39%) and 113 patients (61%), respectively. Seventy-one patients (39%) with partial and complete response were treated with PCI. Metachronous BMs were detected in 16 (23%) of 71 patients in the PCI group compared to 42 (37%) of 113 patients in the non-PCI group. Median BMFS in the PCI group was not reached; it was 23.6 months in the non-PCI group. Median OS and TTP were 26 months (range, 19.4-32.6 months) in the PCI group versus 14 months (range, 11.4-16.6 months) in patients without PCI whose disease responded to therapy versus 9 months in patients with disease that did not respond to therapy (P < .0001), and 27 versus 14.5 months (range, 9.0-19.9 months) versus 8.8 months (range, 7.7-9.9 months) (P < .0001) in the PCI group versus those with response without PCI versus those with nonresponse. The effect of PCI was independent of gender. On multivariate analysis, PCI was a variable correlating with OS (hazard ratio = 1.899; 95% confidence interval, 1.370-2.632; P < .0001) and TTP (hazard ratio = 2.164; 95% confidence interval, 1.371-3.415; P = .001) after adjustment for other prognostic factors. CONCLUSION In real-life patients comprehensively staged with cranial magnetic resonance imaging, treatment response and PCI strongly correlated with prolonged OS, TTP, and BMFS.
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Affiliation(s)
- Chukwuka Eze
- Department of Radiation Oncology, LMU Munich, Munich, Germany
| | | | | | - Guido Hildebrandt
- Department of Radiation Oncology, University of Rostock, Rostock, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU Munich, Munich, Germany; Comprehensive Pneumology Center, The German Center for Lung Research, Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, LMU Munich, Munich, Germany.
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Woolf DK, Slotman BJ, Faivre-Finn C. The Current Role of Radiotherapy in the Treatment of Small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2016; 28:712-719. [PMID: 27522475 DOI: 10.1016/j.clon.2016.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/09/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
Radiotherapy has been shown to play a key role in the management of small cell lung cancer. There are well-established data in the literature for the use of concurrent chemoradiotherapy for stage I-III disease, although key questions remain over the timing of radiation, the optimal dose/fractionation and particularly once versus twice daily treatment, the use of elective nodal irradiation and drug combinations. Data for the use of thoracic radiation in stage IV disease, after chemotherapy, have recently become available and are leading to a change in practice. Prophylactic cranial irradiation has been shown to be of use in both stage I-III and stage IV disease, although uncertainties surround its use in the elderly population and the use of brain imaging before treatment. This overview will address the current available evidence and focus on areas for future research.
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Affiliation(s)
- D K Woolf
- The Christie Hospital NHS Foundation Trust, Manchester, UK.
| | - B J Slotman
- VU University Medical Center, Amsterdam, The Netherlands
| | - C Faivre-Finn
- The Christie Hospital NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), Manchester, UK
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Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N, Saito T. Treatment outcomes of patients with small cell lung cancer without prophylactic cranial irradiation. J Thorac Dis 2016; 8:2571-2579. [PMID: 27747011 DOI: 10.21037/jtd.2016.08.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prophylactic cranial irradiation (PCI) is indicated for limited disease (LD) in small cell lung cancer (SCLC) patients who achieve a complete or near-complete response; however, it is sometimes not administered because of possible adverse reactions or patient refusal. Here we assessed treatment outcomes among patients with SCLC who were not treated with PCI. METHODS The medical records of 60 patients (45 men, 15 women; mean age, 68 years; age range, 51-82 years) with SCLC were retrospectively reviewed. The tumors were staged by TNM classification. Two, 2, 5, 4, 32, and 15 patients had stage IA, IB, IIA, IIB, IIIA, and IIIB tumors, respectively. The patients were treated with thoracic radiotherapy (TRT) and four courses of chemotherapy. RESULTS Our subjects had a median survival of 25 months and 2- and 5-year survival rates of 52.6% and 25.3%, respectively. Univariate analysis revealed that the development of brain metastasis, performance status (PS), and T-stage were significant factors correlated with survival rate. Multivariate analysis identified only PS [hazard ratio (HR), 5.845, 95% confidence interval (CI), 2.333-14.63, P=0.002] and brain metastasis as independent prognostic variables (HR, 2.344, 95% CI, 1.071-5.128, P=0.033). CONCLUSIONS The results of our study demonstrated that the outcomes of treatment without PCI were improved, as compared with those of previously published data. Our findings may be used as reference data when PCI cannot be performed.
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Affiliation(s)
- Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
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Marr AS, Ganti AK. Resected small cell lung cancer-what do we do next? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:288. [PMID: 27568662 DOI: 10.21037/atm.2016.05.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alissa S Marr
- Division of Oncology-Hematology, Department of Internal Medicine, Bellevue Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Apar Kishor Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, NE, USA
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Shahi J, Wright JR, Gabos Z, Swaminath A. Management of small-cell lung cancer with radiotherapy-a pan-Canadian survey of radiation oncologists. ACTA ACUST UNITED AC 2016; 23:184-95. [PMID: 27330347 DOI: 10.3747/co.23.3023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The management of small-cell lung cancer (sclc) with radiotherapy (rt) varies, with many treatment regimens having been described in the literature. We created a survey to assess patterns of practice and clinical decision-making in the management of sclc by Canadian radiation oncologists (ros). METHODS A 35-item survey was sent by e-mail to Canadian ros. The questions investigated the role of rt, the dose and timing of rt, target delineation, and use of prophylactic cranial irradiation (pci) in limited-stage (ls) and extensive-stage (es) sclc. RESULTS Responses were received from 52 eligible ros. For ls-sclc, staging (98%) and simulation or dosimetric (96%) computed tomography imaging were key determinants of rt suitability. The most common dose and fractionation schedule was 40-45 Gy in 15 once-daily fractions (40%), with elective nodal irradiation performed by 31% of ros. Preferred management of clinical T1/2aN0 sclc favoured primary chemoradiotherapy (64%). For es-sclc, consolidative thoracic rt was frequently offered (88%), with a preferred dose and fractionation schedule of 30 Gy in 10 once-daily fractions (70%). Extrathoracic consolidative rt would not be offered by 23 ros (44%). Prophylactic cranial irradiation was generally offered in ls-sclc (100%) and es-sclc (98%) after response to initial treatment. Performance status, baseline cognition, and pre-pci brain imaging were important patient factors assessed before an offer of pci. CONCLUSIONS Canadian ros show practice variation in sclc management. Future clinical trials and national treatment guidelines might reduce variability in the treatment of early-stage disease, optimization of dose and targeting in ls-sclc, and definition of suitability for pci or consolidative rt.
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Affiliation(s)
- J Shahi
- Department of Oncology, McMaster University, Hamilton, ON
| | - J R Wright
- Department of Oncology, McMaster University, Hamilton, ON;; Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON
| | - Z Gabos
- Department of Oncology, University of Edmonton, Edmonton, AB.; Cross Cancer Institute at Alberta Health Services, Edmonton, AB
| | - A Swaminath
- Department of Oncology, McMaster University, Hamilton, ON;; Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON
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Prophylactic cranial irradiation in 399 patients with limited-stage small cell lung cancer. Oncol Lett 2016; 11:2654-2660. [PMID: 27073534 DOI: 10.3892/ol.2016.4231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 01/19/2016] [Indexed: 12/12/2022] Open
Abstract
The benefit of prophylactic cranial irradiation (PCI) in limited-stage small-cell lung cancer (LS-SCLC) was established in a meta-analysis performed in 1999. Since then, considerable progress has been made in the diagnosis, staging and treatment of LS-SCLC, including chemotherapy and radiotherapy, which led to a longer survival time in patients. Therefore, the magnitude of the benefit of PCI should be re-evaluated. Furthermore, the optimum timing of PCI for LS-SCLC treatment has not been established and more data is required to demonstrate this. In the present retrospective study, the cases of patients that were diagnosed with LS-SCLC between March 2005 and December 2010 were reviewed. The main eligibility criteria of patients were a diagnosis of LS-SCLC and the achievement of a complete response (CR) or near CR subsequent to receiving ≥3 cycles of cisplatin-based chemotherapy, with or without advanced thoracic radiotherapy. Early and late PCI groups were separated using the median time interval between the start of primary chemotherapy and the start of PCI. In total, 80 patients were excluded from the analysis, including 9 patients that developed brain metastases, 2 during primary chemotherapy and 7 during radiotherapy. The remaining 399 patients were deemed eligible. PCI was administered to 185 patients; 92 patients were in the early PCI group and 93 were in the late PCI group. PCI significantly decreased the incidence of brain metastases [P<0.001; HR, 0.24; 95% confidence interval (CI), 0.15-0.39] and improved the overall survival time of the patients (median survival time, 21.5-38.8 months; P<0.001; HR, 0.60; 95% CI, 0.45-0.79). However, no significant difference was identified between the early and late PCI groups, either in the incidence of brain metastases (P=0.875) or the overall survival time (P=0.361). Multivariate analysis revealed that PCI (P=0.004) and thoracic radiotherapy (P=0.023) were the only 2 independent favorable prognostic factors of overall survival time. The present study demonstrates that PCI may be of considerable benefit to increase the survival rate and time of patients, and early PCI is as effective as late PCI. However, the present study recommends that PCI should be offered as soon as primary chemotherapy is completed, since there is a greater risk of developing brain metastases during thoracic radiotherapy.
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Almquist D, Mosalpuria K, Ganti AK. Multimodality Therapy for Limited-Stage Small-Cell Lung Cancer. J Oncol Pract 2016; 12:111-7. [DOI: 10.1200/jop.2015.009068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Limited-stage small-cell lung cancer (SCLC) occurs in only one third of patients with SCLC, but it is potentially curable. Combined-modality therapy (chemotherapy and radiotherapy) has long been the mainstay of therapy for this condition, but more recent data suggest a role for surgery in early-stage disease. Prophylactic cranial irradiation seems to improve outcomes in patients who have responded to initial therapy. This review addresses the practical aspects of staging and treatment of patients with limited-stage SCLC.
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Affiliation(s)
- Daniel Almquist
- University of Nebraska Medical Center; and Veterans Administration Nebraska–Western Iowa Health Care System, Omaha, NE
| | - Kailash Mosalpuria
- University of Nebraska Medical Center; and Veterans Administration Nebraska–Western Iowa Health Care System, Omaha, NE
| | - Apar Kishor Ganti
- University of Nebraska Medical Center; and Veterans Administration Nebraska–Western Iowa Health Care System, Omaha, NE
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Ozawa Y, Omae M, Fujii M, Matsui T, Kato M, Sagisaka S, Asada K, Karayama M, Shirai T, Yasuda K, Nakamura Y, Inui N, Yamada K, Yokomura K, Suda T. 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. BMC Cancer 2015; 15:589. [PMID: 26275617 PMCID: PMC4537586 DOI: 10.1186/s12885-015-1593-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 08/05/2015] [Indexed: 12/12/2022] Open
Abstract
Background 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. 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. Methods The 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. Results Of 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). Conclusion PCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available.
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Affiliation(s)
- Yuichi Ozawa
- Department of Respiratory Medicine, Respiratory Disease Center, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan.
| | - Minako Omae
- Department of Respiratory Medicine, Respiratory Disease Center, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Masato Fujii
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-ku, Shizuoka, Shizuoka, 420-8527, Japan
| | - Takashi Matsui
- Department of Respiratory Medicine, Respiratory Disease Center, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Masato Kato
- Department of Respiratory Medicine, Respiratory Disease Center, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Shinya Sagisaka
- Department of Respiratory Medicine, Iwata City Hospital, 512-3 Okubo, Iwata, Shizuoka, 438-0002, Japan
| | - Kazuhiro Asada
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-ku, Shizuoka, Shizuoka, 420-8527, Japan
| | - Masato Karayama
- Department of Clinical Oncology, 1-20-1 Handayama, Higashi Ward, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-ku, Shizuoka, Shizuoka, 420-8527, Japan
| | - Kazumasa Yasuda
- Department of Respiratory Medicine, Iwata City Hospital, 512-3 Okubo, Iwata, Shizuoka, 438-0002, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Naoki Inui
- Department of Clinical Pharmacology and Therapeutics, 1-20-1 Handayama, Higashi Ward, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kazunari Yamada
- Department of Radiation Oncology, Seirei Mikatahara General Hospital, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Respiratory Disease Center, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, Shizuoka, 431-3192, Japan
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Prophylactic Cranial Irradiation for Patients With Locally Advanced Non–Small-Cell Lung Cancer at High Risk for Brain Metastases. Clin Lung Cancer 2015; 16:292-7. [DOI: 10.1016/j.cllc.2014.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/13/2014] [Accepted: 11/18/2014] [Indexed: 11/21/2022]
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Snider JW, Gondi V, Brown PD, Tome W, Mehta MP. Prophylactic cranial irradiation: recent outcomes and innovations. CNS Oncol 2015; 3:219-30. [PMID: 25055130 DOI: 10.2217/cns.14.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Brain metastases represent a frequent problem in several malignancies. They can shorten survival while causing significant morbidity and impairment in the patient's quality of life. Prophylactic cranial irradiation (PCI) has become an integral part of the standard of care in small cell lung cancer (SCLC), yet its role in other malignancies remains the subject of significant discussion. Its role has been extensively investigated in non-small cell lung cancer and less so for breast cancer and other malignancies. Improvements in medical care as well as in whole brain radiotherapy (WBRT) techniques may improve the risk-benefit ratio of this therapy so as to expand its role in cancer care. The use of memantine in WBRT patients as well as the use of hippocampal avoidance techniques are of particular interest in this effort. Herein, we review the history of PCI, its current use, and areas of investigation in the application of PCI.
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Affiliation(s)
- James W Snider
- 22 South Greene Street, Department of Radiation Oncology, Baltimore, MD 21201, USA
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Burotto M, Tageja N, Rosenberg A, Mahalingam S, Quezado M, Velarde M, Edgerly M, Fojo T. Brain metastasis in patients with adrenocortical carcinoma: a clinical series. J Clin Endocrinol Metab 2015; 100:331-6. [PMID: 25412413 PMCID: PMC4318908 DOI: 10.1210/jc.2014-2650] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a heterogeneous and rare disease. At presentation or at the time of a recurrence, the disease commonly spreads to the liver, lungs, lymph nodes, and bones. The brain has only rarely been reported as a site of metastases. OBJECTIVE The aims of this report were to describe the clinical characteristics of patients with ACC who developed brain metastasis and were evaluated at the National Cancer Institute. METHODS We describe the history and clinical presentation of six patients with ACC and metastatic disease in the brain. Images of the six patients and pathology slides were reviewed when available. RESULTS The median age at the time of the diagnosis of ACC was 42 years. The median time from the initial diagnosis until the presentation of brain metastasis was 43 months. As a group the patients had previously received multiples lines of chemotherapy (median of three), and they presented with one to three metastatic brain lesions. Four patients underwent metastasectomy, one had radiosurgery, and one had both modalities. Two patients are still alive, three died, between 2 and 14 months after the diagnosis of brain metastases, and one was lost to follow-up. CONCLUSION Patients with advanced ACC can rarely present with metastasis to the brain, most often long after the initial diagnosis. Timely diagnosis of brain metastasis with appropriate intervention after discussion in a multidisciplinary meeting can improve the prognosis in this particular scenario.
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Affiliation(s)
- Mauricio Burotto
- Center for Cancer Research (M.B., N.T., M.V., M.E., T.F.) and National Laboratory of Pathology (A.R., M.Q.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; and The George Washington University (S.M.), Rockville, Maryland 20852
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Value of oncogenes for the prediction of brain metastases at initial diagnosis: a review of published data. Int J Biol Markers 2014; 29:e291-300. [PMID: 24832179 DOI: 10.5301/jbm.5000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/20/2022]
Abstract
Identifying cancer patients who are at high risk of developing brain metastases at initial diagnosis and applying effective intervention or monitoring strategies is of vital importance. Recent advances in the biology of brain metastases revealed that some oncogenes from primary tumors may be potential markers for identifying cancer patients likely to metastasize to the brain. We here summarize data on the mechanisms of brain metastases supporting the involvement of oncogene changes in the brain metastatic evolution. We also review the available evidence on clinical studies of oncogenes in the prediction of cancer patients with high incidence of brain metastases.
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Rule WG, Foster NR, Meyers JP, Ashman JB, Vora SA, Kozelsky TF, Garces YI, Urbanic JJ, Salama JK, Schild SE. Prophylactic cranial irradiation in elderly patients with small cell lung cancer: findings from a North Central Cancer Treatment Group pooled analysis. J Geriatr Oncol 2014; 6:119-26. [PMID: 25482023 DOI: 10.1016/j.jgo.2014.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/19/2014] [Accepted: 11/20/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine the efficacy of prophylactic cranial irradiation (PCI) in elderly patients with small cell lung cancer (SCLC) (≥70 years of age) from a pooled analysis of four prospective trials. MATERIALS & METHODS One hundred fifty-five patients with SCLC (limited stage, LSCLC, and extensive stage, ESCLC) participated in four phase II or III trials. Ninety-one patients received PCI (30 Gy/15 or 25 Gy/10) and 64 patients did not receive PCI. Survival was compared in a landmark analysis that included only patients who had stable disease or better in response to primary therapy. RESULTS Patients who received PCI had better survival than patients who did not receive PCI (median survival 12.0 months vs. 7.6 months, 3-year overall survival 13.2% vs. 3.1%, HR = 0.53 [95% CI 0.36-0.78], p = 0.001). On multivariate analysis of the entire cohort, the only factor that remained significant for survival was stage (ESCLC vs. LSCLC, p = 0.0072). In contrast, the multivariate analysis of patients who had ESCLC revealed that PCI was the sole factor associated with a survival advantage (HR = 0.47 [95% CI 0.24-0.93], p = 0.03). Grade 3 or higher adverse events (AEs) were significantly greater in patients who received PCI (71.4% vs. 47.5%, p = 0.0031), with non-neuro and non-heme being the specific AE categories most strongly correlated with PCI delivery. CONCLUSIONS PCI was associated with a significant improvement in survival for our entire elderly SCLC patient cohort on univariate analysis. Multivariate analysis suggested that the survival advantage remained significant in patients with ESCLC. PCI was also associated with a modest increase in grade 3 or higher AEs.
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Affiliation(s)
- William G Rule
- Department of Radiation Oncology, Mayo Clinic Arizona, USA.
| | - Nathan R Foster
- Section of Biomedical Statistics and Informatics, Mayo Clinic Rochester, USA
| | - Jeffrey P Meyers
- Section of Biomedical Statistics and Informatics, Mayo Clinic Rochester, USA
| | | | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Arizona, USA
| | | | | | - James J Urbanic
- Department of Radiation Oncology, Wake Forest School of Medicine, USA
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University School of Medicine, USA
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Zhu H, Guo H, Shi F, Zhu K, Luo J, Liu X, Kong L, Yu J. Prophylactic cranial irradiation improved the overall survival of patients with surgically resected small cell lung cancer, but not for stage I disease. Lung Cancer 2014; 86:334-8. [DOI: 10.1016/j.lungcan.2014.09.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/06/2014] [Accepted: 09/10/2014] [Indexed: 11/26/2022]
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