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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, H J; Stella, P J; Garces, Y I; Olivier, K R; Molina, J R; Past, L R; Adjei, A A.
Afiliación
  • Schild SE; Department of Radiation Oncology, Mayo Clinic, Scottsdale. Electronic address: sschild@mayo.edu.
  • Foster NR; Section of Biomedical Statistics and Informatics, Mayo Clinic, Rochester.
  • Meyers JP; Section of Biomedical Statistics and Informatics, Mayo Clinic, Rochester.
  • Ross HJ; Division of Medical Oncology, Mayo Clinic.
  • Stella PJ; Michigan Cancer Research Consortium, Ann Arbor.
  • Garces YI; Department of Radiation Oncology, Mayo Clinic, Rochester.
  • Olivier KR; Department of Radiation Oncology, Mayo Clinic, Rochester.
  • Molina JR; Department of Medical Oncology, Mayo Clinic, Rochester.
  • Past LR; Department of Radiation Oncology, Luther Hospital Eau Claire.
  • Adjei AA; Department of Radiation Oncology, Mayo Clinic, Rochester.
Ann Oncol ; 23(11): 2919-2924, 2012 Nov.
Article en En | MEDLINE | ID: mdl-22782333
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Irradiación Craneana / Carcinoma Pulmonar de Células Pequeñas / Neoplasias Pulmonares Tipo de estudio: Diagnostic_studies Límite: Adult / Aged / Aged80 / Humans / Middle aged Idioma: En Revista: Ann Oncol Asunto de la revista: NEOPLASIAS Año: 2012 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Irradiación Craneana / Carcinoma Pulmonar de Células Pequeñas / Neoplasias Pulmonares Tipo de estudio: Diagnostic_studies Límite: Adult / Aged / Aged80 / Humans / Middle aged Idioma: En Revista: Ann Oncol Asunto de la revista: NEOPLASIAS Año: 2012 Tipo del documento: Article Pais de publicación: Reino Unido