Outcomes of prophylactic cranial irradiation in patients with small cell lung cancer in the modern era of baseline magnetic resonance imaging of the brain

Mads Kjaergaard Held, Olfred Hansen, Tine Schytte, Karin Holmskov Hansen, Rana Bahij, Morten Nielsen, Tine Bjørn Nielsen, Stefan Starup Jeppesen

Research output: Contribution to journalConference articleResearchpeer-review

Abstract

BACKGROUND: For decades many patients with small cell lung cancer (SCLC) have been offered prophylactic cranial irradiation (PCI) to prevent brain metastases (BM). However, the role of PCI is debated in the modern era of increased brain magnetic resonance imaging (MRI) availability. BM in SCLC patients may respond to chemotherapy, and if a negative MRI is used in the decision to use of PCI in the treatment strategy, the timing of brain MRI may be crucial when evaluating the effect of PCI. This retrospective study investigates the impact of PCI outcomes in patients with SCLC staged with brain MRI prior to chemotherapy.

MATERIALS AND METHODS: This study included 245 patients diagnosed SCLC/mixed NSCLC-SCLC treated between 2012 and 2019. The population was analyzed separately for limited disease (LS-SCLC) and extensive disease (ES-SCLC). Patients were divided into groups based on baseline brain MRI prior to chemotherapy and PCI. The primary endpoint was time to symptomatic BM. Secondary endpoints were overall survival (OS), and progression-free survival (PFS).

RESULTS: In patients with LS-SCLC staged with brain MRI the probability of developing symptomatic BM at one year was 4% vs. 22% (p < 0.05), median OS was 55 vs. 24 months (p < 0.05), and median PFS was 30 vs. 10 months (p < 0.05) with and without PCI, respectively. No differences in probability of symptomatic BM and survival outcomes were observed in ES-SCLC. In a multivariate regression analysis, no variables were statistically significant associated with the risk of developing symptomatic BM in patients with LS-SCLC and ES-SCLC. For patients with ES-SCLC staged with brain MRI, PS (HR = 3.33, CI; 1.41-7.89, p < 0.05) was associated with poor survival.

CONCLUSION: This study found that PCI in LS-SCLC patients staged with brain MRI had lower incidence of symptomatic BM and improved survival outcomes suggesting PCI as standard of care. Similar benefit of PCI in patients with ES-SCLC was not found.

Original languageEnglish
JournalActa Oncologica
Volume61
Issue number2
Pages (from-to)185-192
ISSN0284-186X
DOIs
Publication statusPublished - Feb 2022
Event20th Acta Oncologica symposium: BiGART 2021 - Biology-Guided Adaptive Radiotherapy - Middelfart, Denmark
Duration: 5. Oct 20216. Oct 2021

Conference

Conference20th Acta Oncologica symposium: BiGART 2021 - Biology-Guided Adaptive Radiotherapy
Country/TerritoryDenmark
CityMiddelfart
Period05/10/202106/10/2021

Keywords

  • Small-cell lung cancer; prophylactic cranial irradiation; brain magnetic resonance imaging; brain metastases; limited-stage small-cell lung cancer; extensive-stage small-cell lung cancer
  • Lung Neoplasms/diagnostic imaging
  • Brain
  • Magnetic Resonance Imaging
  • Small Cell Lung Carcinoma/diagnostic imaging
  • Brain Neoplasms/diagnostic imaging
  • Humans
  • Retrospective Studies
  • Cranial Irradiation

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