|Table of Contents|

Analysis of risk factors for brain metastasis in patients with limited stage small cell lung cancer after prophylactic cranial irradiation

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2023 10
Page:
1894-1899
Research Field:
Publishing date:

Info

Title:
Analysis of risk factors for brain metastasis in patients with limited stage small cell lung cancer after prophylactic cranial irradiation
Author(s):
LI Mingxu; HU Songliu
Department of Thoracic Radiation Oncology,Harbin Medical University Cancer Hospital,Heilongjiang Harbin 150081,China.
Keywords:
small cell lung cancer; prophylactic cranial irradiation; brain metastasis; risk factor
PACS:
R734.2
DOI:
10.3969/j.issn.1672-4992.2023.10.023
Abstract:
Objective:To analyse the risk factors for brain metastases in patients with limited stage small cell lung cancer （LS-SCLC） after prophylactic cranial irradiation (PCI),and to identify characteristics of patients who can benefit from PCI,providing a reference for the clinical application of PCI.Methods:We reviewed the medical records of 167 LS-SCLC patients who underwent PCI in our hospital from August 2011 to December 2019.Statistical analysis of the medical records was performed by the SPSS 26.0 statistical software.The Kaplan-Meier method and Log-rank test were used to evaluate the risk of developing brain metastases and patient overall survival.Univariate and multivariate Cox regression analysis were explored to estimate risk variables for brain metastases and overall survival.Results:The 1-,2-,and 3-year brain metastasis rates of LS-SCLC patients after PCI were 3.8%,12.7% and 18.9%,respectively.The results of univariate and multivariate analysis showed that the primary tumor extent (T4 stage) was the independent risk factor for brain metastasis after PCI (P=0.004,HR=7.06,95%CI:1.86~26.82).Tumor stage T2 (P=0.008,HR=2.48,95%CI:1.26~4.89),T3 (P=0.003,HR=3.38,95%CI:1.49~7.47) and T4 (P=0.001,HR=3.87,95%CI:1.79~8.35) were the risk factors for overall survival of patients after PCI.Conclusion:The higher T stage was an independent risk factor for brain mtastases and overall survival in patients with LS-SCLC after PCI.Even though the incidence of brain metastasis in stage T4 patients after PCI was higher than other stages,they were still able to benefit from PCI.

References:

[1] BRAY F,FERLAY J,SOERJOMATARAM I,et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries［J］.CA Cancer J Clin,2018,68(6):394-424.
[2] MICKE P,FALDUM A,METZ T,et al.Staging small cell lung cancer:veterans administration lung study group versus international association for the study of lung cancer-what limits limited disease［J］.Lung Cancer,2002,37(3):271-276.
[3] CHU X,LI S,XIA B,et al.Patterns of brain metastasis immediately before prophylactic cranial irradiation (PCI):implications for PCI optimization in limited-stage small cell lung cancer［J］.Radiat Oncol,2019,14(1):171.
[4] MARSH JC,HERSKOVIC AM,GIELDA BT,et al.Intracranial metastatic disease spares the limbic circuit:a review of 697 metastatic lesions in 107 patients［J］.Int J Radiat Oncol Biol Phys,2010,76(2):504-512.
[5] VAN VULPEN M,KAL HB,TAPHOORN MJ,et al.Changes in blood-brain barrier permeability induced by radiotherapy:implications for timing of chemotherapy? (Review)［J］.Oncol Rep,2002,9(4):683-688.
[6] AUPERIN A,ARRIAGADA R,PIGNON JP,et al.Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission.Prophylactic cranial irradiation overview collaborative group［J］.N Engl J Med,1999,341(7):476-484.
[7] PEZZI T A,FANG P,GJYSHI O,et al.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［J］.Jama Netw Open,2020,3(4):e201929.
[8] GONDI V,PUGH SL,TOME WA,et al.Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933):a phase II multi-institutional trial［J］.J Clin Oncol,2014,32(34):3810-3816.
[9] SAKAGUCHI M,MAEBAYASHI T,AIZAWA T,et al.Treatment outcomes of patients with small cell lung cancer without prophylactic cranial irradiation［J］.J Thorac Dis,2016,8(9):2571-2579.
[10] ZENG H,XIE P,MENG X,et al.Risk factors for brain metastases after prophylactic cranial irradiation in small cell lung cancer［J］.Sci Rep,2017,7:42743.
[11] ZHENG Y,WANG L,ZHAO W,et al.Risk factors for brain metastasis in patients with small cell lung cancer without prophylactic cranial irradiation［J］.Strahlenther Onkol,2018,194(12):1152-1162.
[12] LEVY A,LE PECHOUX C,MISTRY H,et al.Prophylactic cranial irradiation for limited-stage small-cell lung cancer patients:secondary findings from the prospective randomized phase 3 convert trial［J］.J Thorac Oncol,2019,14(2):294-297.
[13] REDDY SP,DOWELL JE,PAN E.Predictors of prognosis of synchronous brain metastases in small-cell lung cancer patients［J］.Clin Exp Metastasis,2020,37(4):531-539.
[14] WANG X,MA K,YANG Z,et al.Systematic correlation analyses of circulating tumor cells with clinical variables and tumor markers in lung cancerr patients［J］.J Cancer,2017,8(15):3099-3104.
[15] HELD MK,HANSEN O,SCHYTTE T,et al.Outcomes of prophylactic cranial irradiation in patients with small cell lung cancer in the modern era of baseline magnetic resonance imaging of the brain［J］.Acta Oncol,2022,61(2):185-192.
[16] KIM TG,PYO H,AHN YC,et al.Role of prophylactic cranial irradiation for elderly patients with limited-disease small-cell lung cancer:inverse probability of treatment weighting using propensity score［J］.J Radiat Res,2019,60(5):630-638.
[17] FAROOQI AS,HOLLIDAY EB,ALLEN PK,et al.Prophylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer:do all patients benefit［J］.Radiother Oncol,2017,122(2):307-312.
[18] GUO D,JING W,ZHU H,et al.Clinical value of carcinoembryonic antigen for predicting the incidence of brain metastases and survival in small cell lung cancer patients treated with prophylactic cranial irradiation［J］.Cancer Manag Res,2018,10:3199-3205.
[19] WOLFSON AH,BAE K,KOMAKI R,et al.Primary analysis of a phase II randomized trial Iadiation Therapy Oncology Group (RTOG) 0212:impact of different total doses and schedules of prophylactic cranial irradiation on chronic neurotoxicity and quality of life for patients with limited-disease small-cell lung cancer［J］.Int J Radiat Oncol Biol Phys,2011,81(1):77-84.
[20] MANAPOV F,KLOCKING S,NIYAZI M,et al.Primary tumor response to chemoradiotherapy in limited-disease small-cell lung cancer correlates with duration of brain-metastasis free survival［J］.J Neurooncol,2012,109(2):309-314.
[21] YONEMORI K,SUMI M,FUJIMOTO N,et al.Pro-gastrin-releasing peptide as a factor predicting the incidence of brain metastasis in patients with small cell lung carcinoma with limited disease receiving prophylactic cranial irradiation［J］.Cancer,2005,104(4):811-816.
[22] SAS-KORCZYNSKA B,KORZENIOWSKI S,WOJCIK E.Comparison of the effectiveness of "late" and "early" prophylactic cranial irradiation in patients with limited-stage small cell lung cancer［J］.Strahlenther Onkol,2010,186(6):315-319.
[23] BELDERBOS J,DE RUYSSCHER D,DE JAEGER K,et al.Phase 3 randomized trial of prophylactic cranial irradiation with or without hippocampus avoidance in SCLC (NCT01780675)［J］.J Thorac Oncol,2021,16(5):840-849.
[24] HARTH S,ABO-MADYAN Y,ZHENG L,et al.Estimation of intracranial failure risk following hippocampal-sparing whole brain radiotherapy［J］.Radiother Oncol,2013,109(1):152-158.
[25] NAWROCKI S,SUGAJSKA A.Study protocol:watchful observation of patients with limited small cell lung cancer instead of the PCI-prospective,multi-center one-arm study［J］.BMC Cancer,2020,20(1):231.
[26] FIEVET L,SCULIER JP,MEERT AP,et al.The role of prophylactic cranial irradiation in small cell lung cancer［J］.Rev Mal Respir,2021,38(2):137-146.

Memo

Memo:
中国医疗手牵手工程委员会-北京医学奖励基金会基金（编号：YXJL-2020-0961-0159）
Last Update: 1900-01-01