Prophylactic cranial irradiation following surgical resection of early-stage small-cell lung cancer

A review of the literature

Brooke C. Bloom, Alexander Augustyn, Boris Sepesi, Sunil Patel, Shalin J. Shah, Ritsuko U. Komaki, Steven E. Schild, Stephen G. Chun

Research output: Contribution to journalShort survey

2 Citations (Scopus)

Abstract

With increasing use of low-dose screening CT scans, the diagnosis of early-stage small-cell lung cancer (SCLC) without evidence of mediastinal nodal or distant metastasis is likely to become more common, but the role of adjuvant therapies such as prophylactic cranial irradiation (PCI) are not well understood in this population. We performed a review of the literature pertaining to the impact of PCI in patients who underwent surgical resection of early-stage SCLC. Four studies were identified that were pertinent including three single-institution retrospective analyses and a National Cancer Database analysis. Based upon these studies, we estimate the rate of brain metastases to be 10-15% for Stage I and 15-25% for Stage II disease without PCI. However, the impact of PCI on the development of brain metastases and its ultimate impact on overall survival were not consistent across these studies. In summary, there is sparse evidence to guide recommendations for PCI following resection of early-stage SCLC. While it may be reasonable to offer PCI to maximize likelihood of cure, alternative strategies such as observation with close imaging follow-up can also be considered for the appropriate patient given the known neurocognitive side effects of PCI.

Original languageEnglish (US)
Article number228
JournalFrontiers in Oncology
Volume7
Issue numberSEP
DOIs
StatePublished - Sep 29 2017

Fingerprint

Cranial Irradiation
Small Cell Lung Carcinoma
Neoplasm Metastasis
Brain
Observation
Databases
Survival

Keywords

  • Brain metastasis
  • Early stage
  • Prophylactic cranial irradiation
  • Small-cell lung cancer
  • Surgical resection

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Prophylactic cranial irradiation following surgical resection of early-stage small-cell lung cancer : A review of the literature. / Bloom, Brooke C.; Augustyn, Alexander; Sepesi, Boris; Patel, Sunil; Shah, Shalin J.; Komaki, Ritsuko U.; Schild, Steven E.; Chun, Stephen G.

In: Frontiers in Oncology, Vol. 7, No. SEP, 228, 29.09.2017.

Research output: Contribution to journalShort survey

Bloom, Brooke C. ; Augustyn, Alexander ; Sepesi, Boris ; Patel, Sunil ; Shah, Shalin J. ; Komaki, Ritsuko U. ; Schild, Steven E. ; Chun, Stephen G. / Prophylactic cranial irradiation following surgical resection of early-stage small-cell lung cancer : A review of the literature. In: Frontiers in Oncology. 2017 ; Vol. 7, No. SEP.
@article{9d2803522b574d158459ea7b2e45de0f,
title = "Prophylactic cranial irradiation following surgical resection of early-stage small-cell lung cancer: A review of the literature",
abstract = "With increasing use of low-dose screening CT scans, the diagnosis of early-stage small-cell lung cancer (SCLC) without evidence of mediastinal nodal or distant metastasis is likely to become more common, but the role of adjuvant therapies such as prophylactic cranial irradiation (PCI) are not well understood in this population. We performed a review of the literature pertaining to the impact of PCI in patients who underwent surgical resection of early-stage SCLC. Four studies were identified that were pertinent including three single-institution retrospective analyses and a National Cancer Database analysis. Based upon these studies, we estimate the rate of brain metastases to be 10-15{\%} for Stage I and 15-25{\%} for Stage II disease without PCI. However, the impact of PCI on the development of brain metastases and its ultimate impact on overall survival were not consistent across these studies. In summary, there is sparse evidence to guide recommendations for PCI following resection of early-stage SCLC. While it may be reasonable to offer PCI to maximize likelihood of cure, alternative strategies such as observation with close imaging follow-up can also be considered for the appropriate patient given the known neurocognitive side effects of PCI.",
keywords = "Brain metastasis, Early stage, Prophylactic cranial irradiation, Small-cell lung cancer, Surgical resection",
author = "Bloom, {Brooke C.} and Alexander Augustyn and Boris Sepesi and Sunil Patel and Shah, {Shalin J.} and Komaki, {Ritsuko U.} and Schild, {Steven E.} and Chun, {Stephen G.}",
year = "2017",
month = "9",
day = "29",
doi = "10.3389/fonc.2017.00228",
language = "English (US)",
volume = "7",
journal = "Frontiers in Oncology",
issn = "2234-943X",
publisher = "Frontiers Media S. A.",
number = "SEP",

}

TY - JOUR

T1 - Prophylactic cranial irradiation following surgical resection of early-stage small-cell lung cancer

T2 - A review of the literature

AU - Bloom, Brooke C.

AU - Augustyn, Alexander

AU - Sepesi, Boris

AU - Patel, Sunil

AU - Shah, Shalin J.

AU - Komaki, Ritsuko U.

AU - Schild, Steven E.

AU - Chun, Stephen G.

PY - 2017/9/29

Y1 - 2017/9/29

N2 - With increasing use of low-dose screening CT scans, the diagnosis of early-stage small-cell lung cancer (SCLC) without evidence of mediastinal nodal or distant metastasis is likely to become more common, but the role of adjuvant therapies such as prophylactic cranial irradiation (PCI) are not well understood in this population. We performed a review of the literature pertaining to the impact of PCI in patients who underwent surgical resection of early-stage SCLC. Four studies were identified that were pertinent including three single-institution retrospective analyses and a National Cancer Database analysis. Based upon these studies, we estimate the rate of brain metastases to be 10-15% for Stage I and 15-25% for Stage II disease without PCI. However, the impact of PCI on the development of brain metastases and its ultimate impact on overall survival were not consistent across these studies. In summary, there is sparse evidence to guide recommendations for PCI following resection of early-stage SCLC. While it may be reasonable to offer PCI to maximize likelihood of cure, alternative strategies such as observation with close imaging follow-up can also be considered for the appropriate patient given the known neurocognitive side effects of PCI.

AB - With increasing use of low-dose screening CT scans, the diagnosis of early-stage small-cell lung cancer (SCLC) without evidence of mediastinal nodal or distant metastasis is likely to become more common, but the role of adjuvant therapies such as prophylactic cranial irradiation (PCI) are not well understood in this population. We performed a review of the literature pertaining to the impact of PCI in patients who underwent surgical resection of early-stage SCLC. Four studies were identified that were pertinent including three single-institution retrospective analyses and a National Cancer Database analysis. Based upon these studies, we estimate the rate of brain metastases to be 10-15% for Stage I and 15-25% for Stage II disease without PCI. However, the impact of PCI on the development of brain metastases and its ultimate impact on overall survival were not consistent across these studies. In summary, there is sparse evidence to guide recommendations for PCI following resection of early-stage SCLC. While it may be reasonable to offer PCI to maximize likelihood of cure, alternative strategies such as observation with close imaging follow-up can also be considered for the appropriate patient given the known neurocognitive side effects of PCI.

KW - Brain metastasis

KW - Early stage

KW - Prophylactic cranial irradiation

KW - Small-cell lung cancer

KW - Surgical resection

UR - http://www.scopus.com/inward/record.url?scp=85043778426&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043778426&partnerID=8YFLogxK

U2 - 10.3389/fonc.2017.00228

DO - 10.3389/fonc.2017.00228

M3 - Short survey

VL - 7

JO - Frontiers in Oncology

JF - Frontiers in Oncology

SN - 2234-943X

IS - SEP

M1 - 228

ER -