Prophylactic cranial irradiation in small-cell lung cancer: Findings from a North Central Cancer Treatment Group Pooled Analysis

S. E. Schild, N. R. Foster, J. P. Meyers, Helen J Ross, P. J. Stella, Yolanda Isabel Garces, K. R. Olivier, Julian R Molina, L. R. Past, Alex Adjei

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Abstract

Background: This pooled analysis evaluated the outcomes of prophylactic cranial irradiation (PCI) in 739 small-cell lung cancer (SCLC patients with stable disease (SD) or better following chemotherapy ± thoracic radiation therapy (TRT) to examine the potential advantage of PCI in a wider spectrum of patients than generally participate in PCI trials. Patients and methods: Three hundred eighteen patients with extensive SCLC (ESCLC) and 421 patients with limited SCLC (LSCLC) participated in four phase II or III trials. Four hundred fifty-nine patients received PCI (30 Gy/15 or 25 Gy/10) and 280 did not. Survival and adverse events (AEs) were compared. Results: PCI patients survived significantly longer than non-PCI patients {hazard ratio [HR] = 0.61 [95% confidence interval (CI): 0.52-0.72]; P < 0.0001}. The 1- and 3-year survival rates were 56% and 18% for PCI patients versus 32% and 5% for non-PCI patients. PCI was still significant after adjusting for age, performance status, gender, stage, complete response, and number of metastatic sites (HR = 0.82, P = 0.04). PCI patients had significantly more grade 3+ AEs (64%) compared with non-PCI patients (50%) (P = 0.0004). AEs associated with PCI included alopecia and lethargy. Dose fractionation could be compared only for LSCLC patients and 25 Gy/10 was associated with significantly better survival compared with 30 Gy/15 (HR = 0.67, P = 0.018). Conclusions: PCI was associated with a significant survival benefit for both ESCLC and LSCLC patients who had SD or a better response to chemotherapy ± TRT. Dose fractionation appears important. PCI was associated with an increase in overall and specific grade 3+ AE rates.

Original languageEnglish (US)
Article numbermds123
Pages (from-to)2919-2924
Number of pages6
JournalAnnals of Oncology
Volume23
Issue number11
DOIs
StatePublished - Nov 2012

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Cranial Irradiation
Small Cell Lung Carcinoma
Neoplasms
Therapeutics
Dose Fractionation
Survival
Radiotherapy
Thorax
Drug Therapy
Lethargy
Alopecia

Keywords

  • PCI
  • Prophylactic cranial irradiation
  • Radiotherapy
  • Small-cell lung cancer
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Prophylactic cranial irradiation in small-cell lung cancer : Findings from a North Central Cancer Treatment Group Pooled Analysis. / Schild, S. E.; Foster, N. R.; Meyers, J. P.; Ross, Helen J; Stella, P. J.; Garces, Yolanda Isabel; Olivier, K. R.; Molina, Julian R; Past, L. R.; Adjei, Alex.

In: Annals of Oncology, Vol. 23, No. 11, mds123, 11.2012, p. 2919-2924.

Research output: Contribution to journalArticle

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title = "Prophylactic cranial irradiation in small-cell lung cancer: Findings from a North Central Cancer Treatment Group Pooled Analysis",
abstract = "Background: This pooled analysis evaluated the outcomes of prophylactic cranial irradiation (PCI) in 739 small-cell lung cancer (SCLC patients with stable disease (SD) or better following chemotherapy ± thoracic radiation therapy (TRT) to examine the potential advantage of PCI in a wider spectrum of patients than generally participate in PCI trials. Patients and methods: Three hundred eighteen patients with extensive SCLC (ESCLC) and 421 patients with limited SCLC (LSCLC) participated in four phase II or III trials. Four hundred fifty-nine patients received PCI (30 Gy/15 or 25 Gy/10) and 280 did not. Survival and adverse events (AEs) were compared. Results: PCI patients survived significantly longer than non-PCI patients {hazard ratio [HR] = 0.61 [95{\%} confidence interval (CI): 0.52-0.72]; P < 0.0001}. The 1- and 3-year survival rates were 56{\%} and 18{\%} for PCI patients versus 32{\%} and 5{\%} for non-PCI patients. PCI was still significant after adjusting for age, performance status, gender, stage, complete response, and number of metastatic sites (HR = 0.82, P = 0.04). PCI patients had significantly more grade 3+ AEs (64{\%}) compared with non-PCI patients (50{\%}) (P = 0.0004). AEs associated with PCI included alopecia and lethargy. Dose fractionation could be compared only for LSCLC patients and 25 Gy/10 was associated with significantly better survival compared with 30 Gy/15 (HR = 0.67, P = 0.018). Conclusions: PCI was associated with a significant survival benefit for both ESCLC and LSCLC patients who had SD or a better response to chemotherapy ± TRT. Dose fractionation appears important. PCI was associated with an increase in overall and specific grade 3+ AE rates.",
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author = "Schild, {S. E.} and Foster, {N. R.} and Meyers, {J. P.} and Ross, {Helen J} and Stella, {P. J.} and Garces, {Yolanda Isabel} and Olivier, {K. R.} and Molina, {Julian R} and Past, {L. R.} and Alex Adjei",
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T2 - Findings from a North Central Cancer Treatment Group Pooled Analysis

AU - Schild, S. E.

AU - Foster, N. R.

AU - Meyers, J. P.

AU - Ross, Helen J

AU - Stella, P. J.

AU - Garces, Yolanda Isabel

AU - Olivier, K. R.

AU - Molina, Julian R

AU - Past, L. R.

AU - Adjei, Alex

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