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Zheng Z, Zhu D, Liu L, Chen MW, Li G, Geng R, Zhang Y, Huang C, Tian Z, Liu H, Li S, Chen Y. Survival of small-cell lung cancer patients after surgery: A single-center retrospective cohort study. J Investig Med 2023; 71:917-928. [PMID: 37424441 DOI: 10.1177/10815589231185542] [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] [Indexed: 07/11/2023]
Abstract
This study summarized and analyzed the clinical characteristics and prognosis of small-cell lung cancer (SCLC) patients after surgical treatment. The clinical data of 130 patients (99 males and 31 females) with SCLC treated by surgery and confirmed by postoperative pathological examination at Peking Union Medical College Hospital from April 2004 to April 2019 were retrospectively analyzed. Clinical characteristics, surgery, pathological stage, and perioperative treatment were summarized. Kaplan-Meier survival curve and Cox regression analysis were performed. Pathological examination revealed that 36 (27.69%) patients had stage I SCLC, 22 (16.92%) patients had stage II SCLC, 65 (50.00%) patients had stage III SCLC, and 7 (5.39%) patients had stage IV SCLC. The overall median survival time was 50 months (95% confidence interval, 10.8-89.2 months). The median survival time of stage I, II, III and IV SCLC patients was 148, 42, 32, and 10 months, respectively. In patients who underwent surgical treatment, postoperative adjuvant therapy and tumor stage were independent prognostic factors for survival (p < 0.05).Lobectomy and lymph nodes resection combined with adjuvant therapy were cautiously recommended for stage I-IIIa SCLC patients.
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Affiliation(s)
- Zhibo Zheng
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Danyang Zhu
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Michael W Chen
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Guiping Li
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruixuan Geng
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Zhang
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenhuan Tian
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Yang B, Zhang W, Qiu J, Yu Y, Li J, Zheng B. The development and validation of a nomogram for predicting brain metastases after chemotherapy and radiotherapy in male small cell lung cancer patients with stage III. Aging (Albany NY) 2023; 15:6487-6502. [PMID: 37433033 PMCID: PMC10373973 DOI: 10.18632/aging.204865] [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: 03/04/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE The purpose of this research was to develop a model for brain metastasis (BM) in limited-stage small cell lung cancer (LS-SCLC) patients and to help in the early identification of high-risk patients and the selection of individualized therapies. METHODS Univariate and multivariate logic regression was applied to identify the independent risk factors of BM. A receiver operating curve (ROC) and nomogram for predicting the incidence of BM were then conducted based on the independent risk factors. The decision curve analysis (DCA) was performed to assess the clinical benefit of prediction model. RESULTS Univariate regression analysis showed that the CCRT, RT dose, PNI, LLR, and dNLR were the significant factors for the incidence of BM. Multivariate analysis showed that CCRT, RT dose, and PNI were independent risk factors of BM and were included in the nomogram model. The ROC curves revealed the area under the ROC (AUC) of the model was 0.764 (95% CI, 0.658-0.869), which was much higher than individual variable alone. The calibration curve revealed favorable consistency between the observed probability and predicted probability for BM in LS-SCLC patients. Finally, the DCA demonstrated that the nomogram provides a satisfactory positive net benefit across the majority of threshold probabilities. CONCLUSIONS In general, we established and verified a nomogram model that combines clinical variables and nutritional index characteristics to predict the incidence of BM in male SCLC patients with stage III. Since the model has high reliability and clinical applicability, it can provide clinicians with theoretical guidance and treatment strategy making.
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Affiliation(s)
- Baihua Yang
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Wei Zhang
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Jianjian Qiu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Yilin Yu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Jiancheng Li
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Buhong Zheng
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
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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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Zeng H, Zheng D, Witlox WJA, Levy A, Traverso A, Kong FM(S, Houben R, De Ruysscher DKM, Hendriks LEL. Risk Factors for Brain Metastases in Patients With Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:889161. [PMID: 35756675 PMCID: PMC9226404 DOI: 10.3389/fonc.2022.889161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
The use of prophylactic cranial irradiation (PCI) for small cell lung cancer (SCLC) patients is controversial. Risk factors for brain metastasis (BM) development are largely lacking, hampering personalized treatment strategies. This study aimed to identify the possible risk factors for BM in SCLC.We systematically searched the Pubmed database (1 January 1995 to 18 January 2021) according to the PRISMA guidelines. Eligibility criteria: studies reporting detailed BM data with an adequate sample size (randomized clinical trials [RCTs]: N ≥50; non-RCTs: N ≥100) in patients with SCLC. We summarized the reported risk factors and performed meta-analysis to estimate the pooled hazard ratios (HR) if enough qualified data (i.e., two or more studies; the same study type; the same analysis method; and HRs retrievable) were available. In total, 61/536 records were eligible (18 RCTs and 39 non-RCTs comprising 13,188 patients), in which 57 factors were reported. Ten factors qualified BM data for meta-analysis: Limited stage disease (LD) (HR = 0.34, 95% CI: 0.17-0.67; P = 0.002) and older age (≥65) (HR = 0.70, 95% CI: 0.54-0.92; P = 0.01) were associated with less BM; A higher T stage (≥T3) (HR = 1.72, 95% CI: 1.16-2.56; P = 0.007) was a significant risk factor for BM. Male sex (HR = 1.24, 95% CI: 0.99-1.54; P = 0.06) tended to be a risk factor, and better PS (0-1) (HR = 0.66, 95% CI: 0.42-1.02; P = 0.06) tended to have less BM. Smoking, thoracic radiotherapy dose were not significant (P >0.05). PCI significantly decreased BM (P <0.001), but did not improve OS in ED-SCLC (P = 0.81). A higher PCI dose did not improve OS (P = 0.11). The impact on BM was conflicting between Cox regression data (HR = 0.59, 95% CI: 0.26-1.31; P = 0.20) and competing risk regression data (HR = 0.74, 95% CI: 0.55-0.99; P = 0.04). Compared to M0-M1a, M1b was a risk factor for OS (P = 0.01) in ED-SCLC, but not for BM (P = 0.19). As regular brain imaging is rarely performed, high-quality data is lacking. Other factors such as N-stage and blood biomarkers had no qualified data to perform meta-analysis. In conclusion, younger age, higher T stage, and ED are risk factors for BM, suggesting that PCI should be especially discussed in such cases. Individual patient data (IPD) meta-analysis and well-designed RCTs are needed to better identify more risk factors and further confirm our findings. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228391, identifier CRD42021228391.
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Affiliation(s)
- Haiyan Zeng
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Danyang Zheng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Willem J. A. Witlox
- Department of Clinical Epidemiology and Medical Technology Assessment, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Feng-Ming (Spring) Kong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ruud Houben
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Dirk K. M. De Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Lizza E. L. Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
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Chen MY, Ji Y, Hu X, Chen M. Factors Affecting the Risk of Brain Metastasis in Limited-Stage Small Cell Lung Cancer After Prophylactic Cranial Irradiation. Cancer Manag Res 2022; 14:1807-1814. [PMID: 35634538 PMCID: PMC9138691 DOI: 10.2147/cmar.s347449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Prophylactic cranial irradiation (PCI) can reduce the risk of brain metastases (BM) and improve overall survival (OS) in patients with limited-stage small cell lung cancer (LS-SCLC) after partial or complete response to primary therapy. However, some SCLC patients still develop BM after PCI. This study aimed to evaluate the risk factors of BM in patients with LS-SCLC after PCI and identify characteristics of patients who may not benefit from PCI. Methods and Materials We identified 550 patients with LS-SCLC who received chemoradiotherapy at Zhejiang Cancer Hospital between 2002 and 2017. All patients received PCI. Kaplan–Meier analyses and Cox regression analyses were used to identify factors affecting OS and brain metastasis-free survival (BMFS). Results For this patient population, the median survival time was 27.9 months, and the 5-year OS rate was 31%. The median survival time was 24.9 months (95% CI: 22.6–27.2 months), and 30.2 months (95% CI: 24.2–36.3 months) in patients with or without BM (P = 0.000). The overall BM rate was 15.6% (86/550). The frequency of BM in patients with pathologic stages I, II, and III were 9.3% (4/43), 13.4% (7/52), and 16.5% (75/455). The patients with tumors ≥5 cm had an increased risk of BM (HR: 1.781, 95% CI: 1.044–3.039, P = 0.034) but not death (HR: 1.126, 95% CI: 0.925–1.663, P = 0.182). The median survival time among patients <60 years was significantly longer than patients ≥60 years (34.9 months vs 24.6 months, P = 0.001); however, the difference in the BM risk between the two groups was not statistically significant. Conclusion PCI remains the standard of care for LS-SCLC patients who achieve complete or partial response after completion of chemoradiotherapy. However, patients with tumors ≥5 cm may have a higher risk of developing BM after PCI.
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Affiliation(s)
- Meng-Yuan Chen
- Department of Radiation Oncology, Institute of Cancer and Basic Medicine of Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, People’s Republic of China
| | - Yongling Ji
- Department of Radiation Oncology, Institute of Cancer and Basic Medicine of Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, People’s Republic of China
| | - Xiao Hu
- Department of Radiation Oncology, Institute of Cancer and Basic Medicine of Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, People’s Republic of China
| | - Ming Chen
- Department of Radiation Oncology, Institute of Cancer and Basic Medicine of Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, People’s Republic of China
- Correspondence: Ming Chen, Department of Radiation Oncology, Institute of Cancer and Basic Medicine of Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, No. 1, East Banshan Road, Banshan District, Hangzhou, 310022, People’s Republic of China, Email
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Rittberg R, Banerji S, Kim JO, Rathod S, Dawe DE. Treatment and Prevention of Brain Metastases in Small Cell Lung Cancer. Am J Clin Oncol 2021; 44:629-638. [PMID: 34628433 DOI: 10.1097/coc.0000000000000867] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Central nervous system (CNS) metastasis will develop in 50% of small cell lung cancer (SCLC) patients throughout disease course. Development of CNS metastasis poses a particular treatment dilemma due to the accompanied cognitive changes, poor permeability of the blood-brain barrier to systemic therapy and relatively advanced state of disease. Survival of patients with untreated SCLC brain metastases is generally <3 months with whole brain radiotherapy used as first-line management in most SCLC patients. To prevent development of CNS metastasis prophylactic cranial irradiation (PCI) is recommended in limited stage disease, after response to chemotherapy and radiation, while PCI may be considered in extensive stage disease after favorable response to upfront treatment. Neurocognitive toxicity with whole brain radiotherapy and PCI is a concern and remains difficult to predict. The mechanism of toxicity is likely multifactorial, but a potential mechanism of injury to the hippocampus has led to hippocampal sparing radiation techniques. Treatment of established non-small cell lung cancer CNS metastases has increasingly focused on using stereotactic radiotherapy (SRS) and it is tempting to extrapolate these results to SCLC. In this review, we explore the evidence surrounding the prediction, prevention, detection, and treatment of CNS metastases in SCLC. We further review whether existing evidence supports extrapolating less toxic treatments to SCLC patients with CNS metastases and discuss trials that may shed more light on this question.
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Affiliation(s)
- Rebekah Rittberg
- Department of Internal Medicine, University of Manitoba
- Departments of Hematology and Medical Oncology
| | - Shantanu Banerji
- Department of Internal Medicine, University of Manitoba
- Departments of Hematology and Medical Oncology
- Research Institute in Oncology and Hematology at CancerCare Manitoba, Winnipeg, MB, Canada
| | | | | | - David E Dawe
- Department of Internal Medicine, University of Manitoba
- Departments of Hematology and Medical Oncology
- Research Institute in Oncology and Hematology at CancerCare Manitoba, Winnipeg, MB, Canada
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Shan Q, Shi J, Wang X, Guo J, Han X, Wang Z, Wang H. A new nomogram and risk classification system for predicting survival in small cell lung cancer patients diagnosed with brain metastasis: a large population-based study. BMC Cancer 2021; 21:640. [PMID: 34051733 PMCID: PMC8164795 DOI: 10.1186/s12885-021-08384-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/20/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prognosis of patients with small cell lung cancer (SCLC) is poor, most of them are in the extensive stage at the time of diagnosis, and are prone to brain metastasis. In this study, we established a nomogram combined with some clinical parameters to predict the survival of SCLC patients with brain metastasis. METHODS The 3522 eligible patients selected from the SEER database between 2010 and 2015 were randomly divided into training cohort and validation cohort. Univariate and multivariate Cox regression analysis were used to evaluate the ability of each parameter to predict OS. The regression coefficients obtained in multivariate analysis were visualized in the form of nomogram, thus a new nomogram and risk classification system were established. The calibration curves were used to verify the model. And ROC curves were used to evaluate the discrimination ability of the newly constructed nomogram. Survival curves were made by Kaplan-Meier method and compared by Log rank test. RESULTS Univariate and multivariate analysis showed that age, race, sex, T stage, N stage and marital status were independent prognostic factors and were included in the predictive model. The calibration curves showed that the predicted value of the 1- and 3-year survival rate by the nomogram was in good agreement with the actual observed value of the 1- and 3-year survival rate. And, the ROC curves implied the good discrimination ability of the predictive model. In addition, the results showed that in the total cohort, training cohort, and validation cohort, the prognosis of the low-risk group was better than that of the high-risk group. CONCLUSIONS We established a nomogram and a corresponding risk classification system to predict OS in SCLC patients with brain metastasis. This model could help clinicians make clinical decisions and stratify treatment for patients.
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Affiliation(s)
- Qinge Shan
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Jianxiang Shi
- Henan Academy of Medical and Pharmaceutical Sciences, Precision Medicine Center, Zhengzhou University, Zhenzhou, Henan, China
| | - Xiaohui Wang
- Research Service Office, Shandong Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Jun Guo
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Xiao Han
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Zhehai Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
| | - Haiyong Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
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Li J, Jing W, Jia W, Zhai X, Zhu H, Yu J. Downregulation of lncRNA XR_429159.1 Linked to Brain Metastasis in Patients With Limited-Stage Small-Cell Lung Cancer. Front Oncol 2021; 11:603271. [PMID: 34079751 PMCID: PMC8166247 DOI: 10.3389/fonc.2021.603271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/15/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: The purpose of this study was to identify aberrant long non-coding RNAs (lncRNAs) and explore the predictive value of lncRNA expression patterns on the risk of brain metastases (BMs) in patients with limited-stage small-cell lung cancer (SCLC). Patients and Methods: We executed an array of lncRNA and mRNA chip assays to examine the expression in peripheral blood mononuclear cells obtained from SCLC patients with BMs and compared the expression patterns against those from patients without BMs to identify lncRNAs associated with BMs. Validation was performed against clinical data to further confirm the relationship between lncRNAs and BM. Kaplan-Meier analysis was applied to estimate the cumulative incidence of BMs, and differences between the groups were analyzed using the log-rank test. Results: The expression of 67 lncRNAs (27 upregulated and 40 downregulated) and 47 mRNAs (20 upregulated and 27 downregulated) was significantly different between the BM and non-BM groups (fold change ≥ 2.0, p-value ≤ 0.05), based on the lncRNA and mRNA chip assays. Four lncRNAs were verified by quantitative real-time polymerase chain reaction (qRT-PCR) to confirm the accuracy of the microarray data, and the results of 11 patient pairs (11 patients with BM and 11 patients without BM) revealed that low LncRNA XR_429159.1 expression was a high-risk factor for BM. Further clinical data showed that the incidence of BM among 25 patients with low-level LncRNA XR_429159.1 expression was 31% at 1 year, compared with 14.3% among the 18 patients with high-level LncRNA XR_429159.1 expression (p = 0.035). Conclusion: Our present study identified the low-level expression of lncRNA XR_429159.1 as a high-risk factor among BM in patients with limited-stage SCLC. LncRNA XR_429159.1 is a critical molecule that regulates SCLC metastasis, involved in the neuroepithelial transforming gene 1 (NET1) pathway, and serum levels of this lncRNA are significantly associated with the risk of BM.
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Affiliation(s)
- Ji Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wang Jing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wenxiao Jia
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaoyang Zhai
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
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Tai P, Joseph K, Assouline A, Souied O, Leong N, Ferguson M, Yu E. Metastatic Brain Tumors: To Treat or Not to Treat, and with What? CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394715666181211150849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A long time ago, metastatic brain tumors were often not treated and patients were only
given palliative care. In the past decade, researchers selected those with single or 1-3 metastases
for more aggressive treatments like surgical resection, and/or stereotactic radiosurgery (SRS),
since the addition of whole brain radiotherapy (WBRT) did not increase overall survival for the
vast majority of patients. Different studies demonstrated significantly less cognitive deterioration
in 0-52% patients after SRS versus 85-94% after WBRT at 6 months. WBRT is the treatment of
choice for leptomeningeal metastases. WBRT can lower the risk for further brain metastases, particularly
in tumors of fast brain metastasis velocity, i.e. quickly relapsing, often seen in melanoma
or small cell lung carcinoma. Important relevant literature is quoted to clarify the clinical controversies
at point of care in this review. Synchronous primary lung cancer and brain metastasis
represent a special situation whereby the oncologist should exercise discretion for curative treatments,
with reported 5-year survival rates of 7.6%-34.6%. Recent research suggests that those
patients with Karnofsky performance status less than 70, not capable of caring for themselves, are
less likely to derive benefit from aggressive treatments. Among patients with brain metastases
from non-small cell lung cancer (NSCLC), the QUARTZ trial (Quality of Life after Radiotherapy
for Brain Metastases) helps the oncologist to decide when not to treat, depending on the performance
status and other factors.
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Affiliation(s)
- Patricia Tai
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kurian Joseph
- Cross Cancer Center, University of Alberta, Edmonton, AB, Canada
| | - Avi Assouline
- Centre Clinique de la Porte de Saint-Cloud, 30 Rue de Paris, 92100 Boulogne- Billancourt, France
| | - Osama Souied
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nelson Leong
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michelle Ferguson
- Allan Blair Cancer Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Edward Yu
- London Regional Cancer Program, Western University, London, ON, Canada
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Meta-analysis of prophylactic cranial irradiation or not in treatment of extensive-stage small-cell lung cancer: The dilemma remains. Cancer Radiother 2020; 24:44-52. [PMID: 32044160 DOI: 10.1016/j.canrad.2019.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The role of prophylactic cranial irradiation (PCI) in treatment of extensive-stage small-cell lung cancer (SCLC) is controversial. The aim of this study was to systematically evaluate the efficacy and safety of using PCI in the treatment of extensive-stage SCLC. In the present study, we examined whether PCI was essential for the optimal treatment of extensive-disease small-cell lung cancer. MATERIAL AND METHODS We searched the PubMed, Embase, Medline, and China National Knowledge Infrastructure databases to identify articles that assessed the efficacy of PCI in treating extensive-stage small-cell lung cancer patients. RESULTS We identified 8 studies that involved a total of 982 patients who received PCI (PCI group) and a total of 4509 patients who did not receive PCI (control group). The results showed that PCI significantly improved the 1-year overall survival rate (HR=1.50; 95% CI: 1.23-1.82; I2=67%; P<0.0001) and reduced the incidence of brain metastasis (HR=0.46; 95% CI: 0.37-0.58; I2=6%; P<0.00001). CONCLUSION PCI improves the 1-year overall survival rate and reduces the risk of brain metastasis in patients with extensive-stage SCLC.
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Resio BJ, Hoag J, Chiu A, Monsalve A, Dhanasopon AP, Boffa DJ, Blasberg JD. Prophylactic cranial irradiation is associated with improved survival following resection for limited stage small cell lung cancer. J Thorac Dis 2019; 11:811-818. [PMID: 31019769 DOI: 10.21037/jtd.2019.01.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Brain metastases are a major cause of mortality in patients with small cell lung cancer (SCLC). Prophylactic cranial irradiation (PCI) may improve survival among patients that respond to chemotherapy. Less is known about the outcomes of PCI following surgical resection of SCLC. The purpose of this study was to determine if patients who underwent initial surgical resection of SCLC benefit from PCI. Methods Adult patients in the National Cancer Database (NCDB) who underwent complete resection for primary, non-metastatic SCLC between 2004 and 2015 were identified. Patients that received preoperative chemotherapy or who did not receive appropriate adjuvant chemotherapy were excluded. Patients were grouped by treatment with or without cranial radiation within 8 months of resection. Survival was estimated using Kaplan-Meier and Cox multivariable analysis, adjusting for patient and tumor characteristics. Results A total of 859 patients met inclusion criteria (202 received PCI and 657 did not). Kaplan-Meier analysis demonstrated that patients treated with PCI had significantly improved survival compared to no PCI (5-year survival 59% vs. 50%, logrank P=0.0038). Multivariable cox models confirmed a significantly decreased hazard of death for patients receiving PCI (HR: 0.70, 95% CI: 0.55-0.89, P=0.003). In subset analyses, PCI was associated with significantly improved survival for node positive patients, but not node negative patients. Conclusions PCI is associated with increased survival for patients following surgical resection of SCLC. Patients with positive lymph nodes appear to benefit the most, while it remains unclear if patients with negative lymph nodes derive a benefit. Further study is warranted to clarify which subsets of patients should be treated with PCI.
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Affiliation(s)
- Benjamin J Resio
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8062, USA
| | - Jessica Hoag
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8062, USA
| | - Alexander Chiu
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8062, USA
| | - Andres Monsalve
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8062, USA
| | - Andrew P Dhanasopon
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8062, USA
| | - Daniel J Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8062, USA
| | - Justin D Blasberg
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520-8062, USA
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Achrol AS, Rennert RC, Anders C, Soffietti R, Ahluwalia MS, Nayak L, Peters S, Arvold ND, Harsh GR, Steeg PS, Chang SD. Brain metastases. Nat Rev Dis Primers 2019; 5:5. [PMID: 30655533 DOI: 10.1038/s41572-018-0055-y] [Citation(s) in RCA: 529] [Impact Index Per Article: 105.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An estimated 20% of all patients with cancer will develop brain metastases, with the majority of brain metastases occurring in those with lung, breast and colorectal cancers, melanoma or renal cell carcinoma. Brain metastases are thought to occur via seeding of circulating tumour cells into the brain microvasculature; within this unique microenvironment, tumour growth is promoted and the penetration of systemic medical therapies is limited. Development of brain metastases remains a substantial contributor to overall cancer mortality in patients with advanced-stage cancer because prognosis remains poor despite multimodal treatments and advances in systemic therapies, which include a combination of surgery, radiotherapy, chemotherapy, immunotherapy and targeted therapies. Thus, interest abounds in understanding the mechanisms that drive brain metastases so that they can be targeted with preventive therapeutic strategies and in understanding the molecular characteristics of brain metastases relative to the primary tumour so that they can inform targeted therapy selection. Increased molecular understanding of the disease will also drive continued development of novel immunotherapies and targeted therapies that have higher bioavailability beyond the blood-tumour barrier and drive advances in radiotherapies and minimally invasive surgical techniques. As these discoveries and innovations move from the realm of basic science to preclinical and clinical applications, future outcomes for patients with brain metastases are almost certain to improve.
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Affiliation(s)
- Achal Singh Achrol
- Department of Neurosurgery and Neurosciences, John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, CA, USA.
| | - Robert C Rennert
- Department of Neurosurgery, University of California-San Diego, San Diego, CA, USA.
| | - Carey Anders
- Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Manmeet S Ahluwalia
- Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Solange Peters
- Medical Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Nils D Arvold
- Department of Radiation Oncology, St. Luke's Cancer Center, Duluth, MN, USA
| | - Griffith R Harsh
- Department of Neurosurgery, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Patricia S Steeg
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Center, Bethesda, MD, USA
| | - Steven D Chang
- Department of Neurosurgery, University of California-Davis, School of Medicine, Sacramento, CA, USA.
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13
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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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Yin K, Song D, Zhang H, Cai F, Chen J, Dang J. Efficacy of surgery and prophylactic cranial irradiation in stage II and III small cell lung cancer. J Cancer 2018; 9:3500-3506. [PMID: 30310506 PMCID: PMC6171030 DOI: 10.7150/jca.26157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022] Open
Abstract
Background: The role of surgery for stage II and III small cell lung cancer (SCLC) remains controversial. The use of prophylactic cranial irradiation (PCI) for resected SCLC was limited. This study aimed to assess the efficacy of surgery in patients with stage II and III SCLC, and evaluate the value of PCI on resected disease. Methods: A total of 269 consecutive patients with stage II-IIIA SCLC were retrospectively reviewed from January 2010 to December 2015. Of these, 116 patients received surgical resection, and 153 underwent non-surgical treatment. Resected patients were matched 1:1 with non-surgical patients (n=70 in each group). Results: The median follow-up was 30 months. The 1-, 3- and 5-year overall survival (OS) for matched patients were 80.0%, 44.3% and 31.7% in surgical group, and 80.0%, 24.3% and 20.0% in non-surgical group (P=0.009), respectively. Multivariate analysis in matched patients showed that surgery (HR=0.603, 95%CI: 0.404-0.900) and PCI (HR=0.637, 95%CI: 0.427-0.950) were independent prognostic factors for OS. In subgroup analysis, OS benefit related to surgery was marginal for stage II (P=0.09) and IIIA patients (P=0.061), but was significant for selected stage IIIA patients who received adjuvant chemo-radiation and PCI (P=0.01). PCI was associated with improved OS for non-surgical patients (P=0.036), and stage IIIA of surgical patients (P=0.047). Conclusions: These findings suggest a potential OS benefit of surgery in stages II and IIIA patients, particularly in selected stage IIIA patients who received adjuvant chemo-radiation and PCI. The use of PCI for surgical patients with stage IIIA was associated with improved OS.
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Affiliation(s)
- Kunpeng Yin
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Dandan Song
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Hongwei Zhang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Feng Cai
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jun Chen
- Department of Radiation Oncology, Shenyang Chest Hospital, Shenyang, China
| | - Jun Dang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
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15
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Guo D, Jing W, Zhu H, Li M, Zou B, Zhang Y, Fu L, Kong L, Yue J, Yu J. Clinical value of carcinoembryonic antigen for predicting the incidence of brain metastases and survival in small cell lung cancer patients treated with prophylactic cranial irradiation. Cancer Manag Res 2018; 10:3199-3205. [PMID: 30233236 PMCID: PMC6130305 DOI: 10.2147/cmar.s175043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Although the role of prophylactic cranial irradiation (PCI) in the treatment of small cell lung cancer (SCLC) has been confirmed, the occurrence of brain metastases (BM) in patients remains a major problem. We designed this study to evaluate the clinical value of carcinoembryonic antigen (CEA) for predicting the incidence of BM and survival in SCLC patients who received PCI. Materials and methods The records of 128 consecutive SCLC patients, who underwent PCI in our institute between 2005 and 2015, were analyzed. The collected data included clinicopathological features and the levels of CEA, neuron-specific enolase (NSE), cytokeratin 19 fragments (CYFRA21-1), and albumin. Kaplan–Meier and Cox regression analyses were used to determine the factors that affect BM and survival in SCLC patients after PCI. Results In total, 128 patients were identified, with a median (range) age of 62 (30–83) years. Thirty-two patients developed BM at some time during follow-up. The median levels of CEA, NSE, CYFRA21-1, and albumin were 7.6 ng/mL, 44 ng/mL, 4.6 ng/mL, and 42.1 g/L, respectively. In the multivariate analysis, CEA level (HR: 2.479, 95% CI: 1.101–5.581; P=0.028), advanced clinical stage (HR: 2.929, 95% CI: 1.338–6.413; P=0.007), and NSE level (HR: 3.021, 95% CI: 1.226–7.442; P=0.016) were significantly correlated with BM. CEA (HR: 1.903, 95% CI: 1.133–3.195; P=0.015) and advanced clinical stage (HR: 2.002, 95% CI: 1.227–3.267; P=0.005) were independently associated with worse overall survival in SCLC patients. Conclusion CEA is an independent predictive factor for the incidence of BM after PCI in SCLC and can be used as a predictor of BM in SCLC. In addition, a high level of CEA indicates a poor prognosis in SCLC patients after PCI. Prospective randomized clinical studies are required to confirm these findings.
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Affiliation(s)
- Dong Guo
- Department of Oncology, Clinical College, Weifang Medical University, Weifang, Shandong Province, People's Republic of China.,Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ;
| | - Wang Jing
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ; .,Department of Radiotherapy, The First Affiliated Hospital to Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Hui Zhu
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ;
| | - Minghuan Li
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ;
| | - Bing Zou
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ;
| | - Yan Zhang
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ;
| | - Lei Fu
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ;
| | - Li Kong
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ;
| | - Jinbo Yue
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ; .,Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China, ;
| | - Jinming Yu
- Department of Radiotherapy, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, People's Republic of China, ; .,Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China, ;
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16
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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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17
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Le Péchoux C. PCI in resected small-cell lung cancer - Author's reply. Lancet Oncol 2018; 17:e416. [PMID: 27733262 DOI: 10.1016/s1470-2045(16)30455-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France.
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18
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PCI in resected small-cell lung cancer. Lancet Oncol 2018; 17:e415. [PMID: 27733261 DOI: 10.1016/s1470-2045(16)30453-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022]
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Prophylactic Cranial Irradiation for Resectable Small-Cell Lung Cancer. Clin Lung Cancer 2018; 19:115-119. [DOI: 10.1016/j.cllc.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/08/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
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20
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Glatzer M, Schmid S, Radovic M, Früh M, Putora PM. The role of radiation therapy in the management of small cell lung cancer. Breathe (Sheff) 2017; 13:e87-e94. [PMID: 29928456 PMCID: PMC6003267 DOI: 10.1183/20734735.009617] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Small cell lung cancer (SCLC) is a very aggressive form of lung cancer. SCLC treatment requires multidisciplinary management and timely treatment. Radiation therapy is an important part of management of all stages of SCLC, in the curative as well as in the palliative setting. The role of radiation therapy in all stages of SCLC has changed in recent years; this article describes these changes and highlights the role of radiation therapy in the management of SCLC.
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Affiliation(s)
- Markus Glatzer
- Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Sabine Schmid
- Dept of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco Radovic
- Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin Früh
- Dept of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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21
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Wu AJ, Gillis A, Foster A, Woo K, Zhang Z, Gelblum DY, Downey RJ, Rosenzweig KE, Ong L, Perez CA, Pietanza MC, Krug L, Rudin CM, Rimner A. Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation. Radiother Oncol 2017; 125:130-135. [PMID: 28778345 DOI: 10.1016/j.radonc.2017.07.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/05/2017] [Accepted: 07/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The relationship between tumor-node-metastasis (TNM) stage and patterns of failure in limited-stage small cell lung cancer (LS-SCLC) remains unclear. We hypothesized that TNM stage predicts brain metastasis risk, and could inform the use of prophylactic cranial irradiation. MATERIAL AND METHODS We reviewed 283 patients with stage I-IIIB SCLC. Competing-risks regression was used to analyze local, distant, and brain failure. Multivariate analysis was used to evaluate the effect of treatment and clinical factors on failure and OS. RESULTS Patients with stage I or II SCLC (35% of cohort) had significantly better survival and lower risk of distant and brain metastasis, compared with stage III patients. The 5-year cumulative incidence of brain metastasis for stage I/II and III were 12% and 26%, respectively. Stage had no correlation with local failure. On multivariate analysis, stage was independently prognostic for survival, distant metastasis risk, and brain metastasis risk. CONCLUSIONS TNM staging predicts likelihood of distant metastasis, brain metastasis, and survival in LS-SCLC. This supports the routine use of TNM staging in clinical practice. The lower risk of brain metastasis in stage I and II SCLC suggests that prophylactic cranial irradiation could play a more limited role in treatment of early-stage disease.
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Affiliation(s)
- Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States.
| | - Andrea Gillis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Amanda Foster
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Kaitlin Woo
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Daphna Y Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Kenneth E Rosenzweig
- Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States
| | - Leonard Ong
- Department of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Carmen A Perez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - M Catherine Pietanza
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Lee Krug
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Charles M Rudin
- Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
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22
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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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23
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Eze C, Roengvoraphoj O, Manapov F. Prophylactic Cranial Irradiation in Resected Early-Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017; 98:612-614. [PMID: 28581402 DOI: 10.1016/j.ijrobp.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Chukwuka Eze
- Department of Radiation Oncology, LMU Munich, Munich, Germany.
| | | | - Farkhad Manapov
- Department of Radiation Oncology, LMU Munich, Munich, Germany
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Farooqi AS, Holliday EB, Allen PK, Wei X, Cox JD, Komaki R. Prophylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer: Do all patients benefit? Radiother Oncol 2017; 122:307-312. [PMID: 28073578 DOI: 10.1016/j.radonc.2016.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/31/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Prophylactic cranial irradiation (PCI) can improve overall survival (OS) and suppress brain metastases (BM) in patients with limited-stage small cell lung cancer (LS-SCLC) after complete response to primary therapy. However, PCI can be toxic. We sought to identify characteristics of patients who may not benefit from PCI. METHODS We identified 658 patients who received chemoradiotherapy at MD Anderson in 1986-2012; 364 received PCI and 294 did not. Median follow-up time was 21.2months (range 1.2-240.8months). Cox proportional hazards regression, competing-risk regression, and Kaplan-Meier analyses were used to identify factors influencing OS and BM. RESULTS PCI reduced risks of death [HR 0.73, 95% CI 0.61-0.88, P=0.001] and BM [HR 0.54, 95% CI 0.39-0.76, P<0.001]. Having tumors ⩾5cm increased the risk of BM [HR 1.77, 95% CI 1.22-2.55, P=0.002] but not death [HR 1.16, 95% CI 0.96-1.40, P=0.114]. Among patients ⩾70years with ⩾5-cm tumors, PCI did not improve OS [2-year rates 39.4% vs 40.9%, P=0.739]. CONCLUSIONS PCI remains standard therapy after complete response to chemoradiotherapy for LS-SCLC. However, older patients may be at risk from comorbidity or extracranial disease. Further work is warranted to identify patients who may not benefit from PCI.
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Affiliation(s)
- Ahsan S Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Xiong Wei
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - James D Cox
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
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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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Prophylactic Cranial Irradiation for Patients with Surgically Resected Small Cell Lung Cancer. J Thorac Oncol 2016; 12:347-353. [PMID: 27725211 DOI: 10.1016/j.jtho.2016.09.133] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/06/2016] [Accepted: 09/25/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Data on prophylactic cranial irradiation (PCI) after complete resection of SCLC are limited. The purpose of this study was to investigate the impact of PCI in this population. METHODS We retrospectively identified completely resected SCLC at the Shanghai Chest Hospital between January 2006 and January 2014. RESULTS A total of 349 patients (115 patients who received PCI [the PCI-treated cohort] and 234 patients who did not [the non-PCI-treated cohort]) were included in the study. The results demonstrated that the PCI-treated cohort had longer overall survival than the non-PCI-treated cohort among patients with pathologic stage (p-stage) II (hazard ratio [HR] = 0.54, 95% confidence interval [CI]: 0.30-0.99, p = 0.047) and p-stage III (HR = 0.54, 95% CI: 0.34-0.86, p = 0.009) disease. Among patients with p-stage III disease, there was a significantly higher risk for cerebral recurrence from the time of diagnosis in the non-PCI-treated cohort (p = 0.018). With regard to patients with p-stage I disease, neither overall survival benefit (HR = 1.61, 95% CI: 0.68-3.83, p = 0.282) nor risk for cerebral recurrence (p = 0.389) was significant between the PCI-treated and non-PCI-treated cohorts. CONCLUSIONS The data presented in the current study support using PCI in patients with p-stage II/III disease but not in patients with p-stage I disease. A relatively lower risk for brain metastases in p-stage I patients might explain the inferior efficacy of PCI in this population.
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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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Berghoff AS, Ricken G, Wilhelm D, Rajky O, Widhalm G, Dieckmann K, Birner P, Bartsch R, Preusser M. Tumor infiltrating lymphocytes and PD-L1 expression in brain metastases of small cell lung cancer (SCLC). J Neurooncol 2016; 130:19-29. [DOI: 10.1007/s11060-016-2216-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/09/2016] [Indexed: 12/31/2022]
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Abstract
OPINION STATEMENT The standard therapy for limited disease small cell lung cancer (LD-SCLC) is concurrent chemoradiotherapy and prophylactic cranial irradiation (PCI) for those who achieve complete remission (CR) or good partial response (PR) with initial therapy. On the other hand, the standard therapy for extensive disease (ED-SCLC) is chemotherapy only. After the two phase III study conducted by Slotman et al., PCI with/without thoracic radiotherapy (TRT) is also recommended in the treatment of ED-SCLC. However, a Japanese phase III study failed to confirm the benefit of PCI for patients with ED-SCLC. All studies have demonstrated the effectiveness of PCI for preventing brain metastasis, but PCI seems to have a limited influence on OS. In the 2014 edition of the Guidelines for the Treatment of Lung Cancer from the Japan Lung Cancer Society (JLCS), use of PCI for patients with ED-SCLC has been changed from "recommended" to "not recommended". Appropriate selection of patients for PCI with/without TRT is very important. It is hoped that the characteristics of patients for whom PCI with/without TRT should be considered or avoided will be better defined in the future.
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Affiliation(s)
- Kaname Nosaki
- Department of Thoracic Oncology, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
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