The Timing of Prophylactic Cranial Irradiation in Limited-stage Small Cell Lung Cancer
Prophylactic cranial irradiation (PCI) has been considered as standard treatment for patients with limitedstage small cell lung cancer (LS-SCLC) in complete remission following systemic therapy.But it”s uncertain whether delay in delivering PCI after initiation of first chemotherapy cycle will lead to a detrimental outcome.The main eligibility criteria were LS-SCLC, achiving CR or near CR after receiving ≥ 3 cycles of cisplatin-based chemotherapy with or without thoracic radiotherapy.We investigated the different prognosis outcome between patients underwent PCI or not,and between ”early PCI” (administered within 6 months after start of the first chemotherapy cycle) and ”late PCI” (administered 6 months later).From March 2005 to December 2010,399 patients were enrolled in the study.All patients received chemotherapy and 344 patients received thoracic radiotherapy.PCI was administered to 185 patients of which 92 patients had ”early” PCI and 93 had ”late” PCI.The cumulative risks of symptomatic brain metastases at 6, 12 and 24 months were 7%,29% and 42% in no PCI group,0,3% and 13% in PCI group (P=0.000) respectively.The hazard ratio (HR) for the PCI group was 0.24 (95%CI:0.15~0.39).However,no significant difference was found between ”early” PCI group and ”late” PCI group (P=0.875).For the entire group,the median survival was 27.5 months, and overall survival(OS) rates at 1-, 3-year were 89% and 43% respectively.The median survival was 38.8 months in PCI group and 21.5 months in no PCI group (P=0.000;HR=0.60;95%CI: 0.45~0.79).The median survival was 32.6 months in ”early” PCI group and 40.9 months in ”late” PCI group(P=0.361).Multivariate analysis revealed that PCI (P=0.004) and thoracic radiotherapy(P=0.023) were the only 2 independent favorable prognostic factors of OS.PCI significantly decreases the incidence of brain metastases and improves overall survival in patients with LS-SCLC.”Early” PCI is as effective as ”late” PCI.
small cell lung cancer limited stage prophylactic cranial irradiation brain metastases overall survival
Guoqin QIU Xianghui DU Yongling JI Shengye WANG Yaping XU Jianxiang CHEN Xiaojiang SUN Yuanda ZHENG Wei FENG
Department of Radiation Oncology ,Zhejiang Cancer Hospital,Hangzhou 310022,China
国内会议
杭州
英文
86-94
2014-06-27（万方平台首次上网日期，不代表论文的发表时间）