Efficacy of Prophylactic Cranial Irradiation According to the Risk of Extracranial Recurrence in Limited-Stage Small Cell Lung Cancer
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose We aimed to evaluate the effectiveness of prophylactic cranial irradiation (PCI) for “early brain metastasis”, which occurs before extracranial recurrence (ECR), and “late brain metastasis”, which occurs after ECR, in limited-stage small cell lung cancer (LS-SCLC). Materials and Methods We retrospectively analyzed 271 LS-SCLC patients who underwent definitive chemoradiation. All patients were initially staged with brain magnetic resonance imaging and positron emission tomography. Intracranial recurrence (ICR), ECR, progression-free rate (PFR), and overall survival (OS) were analyzed as clinical endpoints. The competing risk of the first recurrence with ICR (ICRfirst) was evaluated. Significantly associated variables in multivariate analysis of ECR were considered as ECR risk factors. Patients were stratified according to the number of ECR risk factors. Results The application of PCI was associated with higher PFR (p=0.008) and OS (p=0.045). However, PCI was not associated with any of the clinical endpoints in multivariate analysis. The competing risk of ICRfirst was significantly decreased with the application of PCI (hazard ratio, 0.476; 95% confidence interval, 0.243 to 0.931; p=0.030). Stage III disease, sequential, and stable disease after thoracic radiation were selected as ECR risk factors. For patients without these risk factors, the application of PCI was significantly associated with increased OS (p=0.048) and a decreased risk of ICRfirst (p=0.026). Conclusion PCI may play a role in preventing early brain metastasis rather than late brain metastasis after ECR, suggesting that only patients with a low risk of ECR may currently benefit from PCI.
Abstract
Purpose We aimed to evaluate the effectiveness of prophylactic cranial irradiation (PCI) for “early brain metastasis”, which occurs before extracranial recurrence (ECR), and “late brain metastasis”, which occurs after ECR, in limited-stage small cell lung cancer (LS-SCLC). Materials and Methods We retrospectively analyzed 271 LS-SCLC patients who underwent definitive chemoradiation. All patients were initially staged with brain magnetic resonance imaging and positron emission tomography. Intracranial recurrence (ICR), ECR, progression-free rate (PFR), and overall survival (OS) were analyzed as clinical endpoints. The competing risk of the first recurrence with ICR (ICRfirst) was evaluated. Significantly associated variables in multivariate analysis of ECR were considered as ECR risk factors. Patients were stratified according to the number of ECR risk factors. Results The application of PCI was associated with higher PFR (p=0.008) and OS (p=0.045). However, PCI was not associated with any of the clinical endpoints in multivariate analysis. The competing risk of ICRfirst was significantly decreased with the application of PCI (hazard ratio, 0.476; 95% confidence interval, 0.243 to 0.931; p=0.030). Stage III disease, sequential, and stable disease after thoracic radiation were selected as ECR risk factors. For patients without these risk factors, the application of PCI was significantly associated with increased OS (p=0.048) and a decreased risk of ICRfirst (p=0.026). Conclusion PCI may play a role in preventing early brain metastasis rather than late brain metastasis after ECR, suggesting that only patients with a low risk of ECR may currently benefit from PCI.
참고문헌 (23)
- 최창민, "Report of the Korean Association of Lung Cancer Registry (KALC-R), 2014", Cancer Research and Treatment, 51(4), pp.1400~1410 (2019), 대한암학회
- Edelman MJ, "Prophylactic cranial irradiation for small-cell lung cancer : time for a reassessment", Am Soc Clin Oncol Educ Book, 40, pp.24~28 (2020)
- Auperin A, "Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group", N Engl J Med, 341, pp.476~484 (1999)
- Hochstenbag MM, "Asymptomatic brain metastases(BM)in small cell lung cancer(SCLC) : MR-imaging is useful at initial diagnosis", J Neurooncol, 48, pp.243~248 (2000)
- Slotman BJ, "Prophylactic cranial irradiation in extensive disease small-cell lung cancer : short-term health-related quality of life and patient reported symptoms : results of an international Phase III randomized controlled trial by the EORTC Radiation Oncology and Lung Cancer Groups", J Clin Oncol, 27, pp.78~84 (2009)
- Takahashi T, "Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer : a multicentre, randomised, open-label, phase 3 trial", Lancet Oncol, 18, pp.663~671 (2017)
- Simone CB 2nd, "Radiation therapy for small cell lung cancer : an ASTRO Clinical Practice Guideline", Pract Radiat Oncol, 10, pp.158~173 (2020)
- Dingemans AC, "Small-cell lung cancer : ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up", Ann Oncol, 32, pp.839~853 (2021)
- Pezzi TA, "Rates of overall survival and intracranial control in the magnetic resonance imaging era for patients with limited-stage small cell lung cancer with and without prophylactic cranial irradiation", JAMA Netw Open, 3, pp.e201929~ (2020)
- Held MK, "Outcomes of prophylactic cranial irradiation in pati-ents with small cell lung cancer in the modern era of baseline magnetic resonance imaging of the brain", Acta Oncol, 61, pp.185~192 (2022)
- Kim TG, "Role of prophylactic cranial irradiation for elderly patients with limited-disease small-cell lung cancer : inverse probability of treatment weighting using propensity score", J Radiat Res, 60, pp.630~638 (2019)
- 고민지, "The value of prophylactic cranial irradiation in limited-stage small cell lung cancer: should it always be recommended?", Radiation oncology journal, 37(3), pp.156~165 (2019), 대한방사선종양학회
- Inoue Y, "Re-evaluation of prophylactic cranial irradiation in limited-stage small cell lung cancer : a propensity score matched analysis", J Radiat Res, 62, pp.877~883 (2021)
- Li J, "Prophylactic cranial irradiation confers favourable prognosis for patients with limited-stage small cell lung cancer in the era of MRI : a propensity score-matched analysis", J Med Imaging Radiat Oncol, 65, pp.778~785 (2021)
- Ghanta S, "Utility of prophylactic cranial irradiation for limited stage small cell lung cancer in the modern era with magnetic resonance imaging surveillance", Clin Oncol(R Coll Radiol), 33, pp.e323~30 (2021)
- Eze C, "Treatment response and prophylactic cranial irradiation are prognostic factors in a real-life limited-disease small-cell lung cancer patient cohort comprehensively staged with cranial magnetic resonance imaging", Clin Lung Cancer, 18, pp.e243~9 (2017)
- Farris MK, "Limited-stage small cell lung cancer: is prophylactic cranial irradiation necessary?", Pract Radiat Oncol, 9, pp.e599~e607 (2019)
- Choi M, "Effect of accurate staging using positron emission tomography on the outcomes of prophylactic cranial irradiation in patients with limited stage small-cell lung cancer", Clin Lung Cancer, 18, pp.77~84 (2017)
- Farooqi AS, "Prophylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer : Do all patients benefit?", Radiother Oncol, 122, pp.307~312 (2017)
- Wu AJ, "Patterns of failure in limited-stage small cell lung cancer : Implications of TNM stage for prophylactic cranial irradiation", Radiother Oncol, 125, pp.130~135 (2017)
- Zheng Y, "Risk factors for brain metastasis in patients with small cell lung cancer without prophylactic cranial irradiation", Strahlenther Onkol, 194, pp.1152~1162 (2018)
- Xu J, "Prophylactic cranial irradiation for patients with surgically resected small cell lung cancer", J Thorac Oncol, 12, pp.347~353 (2017)
- Yang H, "pN1 but not pN0", N2 predicts survival benefits of prophylactic cranial irradiation in small-cell lung cancer patients after surgery, 2021, pp.9, 562~