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Prophylactic cranial irradiation in locally advanced non-small cell lung cancer: outcome of recursive partitioning analysis group 1 patients.

Yavuz AA, Topkan E, Onal C, Yavuz MN - J. Exp. Clin. Cancer Res. (2008)

Bottom Line: By univariate analysis, rates of BM were significantly higher in patients younger than 60 years of age (p = 0.03).Multivariate analysis showed no significant difference in BM-free survival according to gender, age, histology, and initial T- and N-stage.The current finding of almost equal bone metastasis free survival and overall survival in patients with LA-NSCLC in RPA group 1 suggests a longer survival for patients who receive PCI, and thereby have a reduced risk of BM.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Baskent University Medical Faculty, Adana Medical and Research Center, Kisla Saglik Yerleskesi, Adana, Turkey. ayavuz@baskent-adn.edu.tr

ABSTRACT

Background: Prophylactic cranial irradiation (PCI) has been demonstrated to reduce or delay the incidence of brain metastases (BM) in locally advanced non-small cell lung carcinoma (LA-NSCLC) patients with various prognostic groups. With this current cohort we planned to evaluate the potential usefulness of prophylactic cranial irradiation (PCI) specifically in recursive partitioning analysis (RPA) Group 1, which is the most favorable group of LA-NSCLC patients.

Methods: Between March 2007 and February 2008, 62 patients in RPA group 1 were treated with sequential chemoradiotherapy and PCI for stage IIIB NSCLC. The induction chemotherapy consisted of 3 courses of cisplatin (80 mg/m2) and docetaxel (80 mg/m2); each course was given every 21 days. Thoracic radiotherapy (TRT) was given at a dose of 60 Gy using 3-D conformal planning. All patients received a total dose of 30 Gy PCI (2 Gy/fr, 5 days a week), beginning on the first day of the TRT. Then, all patients received 3 further courses of the same chemotherapy protocol.

Results: Six (9.7%) patients developed brain metastases during their clinical course. Only one (2%) patient developed brain metastasis as the site of first treatment failure. Median brain metastasis-free survival, overall survival, and progression free survival were 16.6, 16.7, and 13.0 months, respectively. By univariate analysis, rates of BM were significantly higher in patients younger than 60 years of age (p = 0.03). Multivariate analysis showed no significant difference in BM-free survival according to gender, age, histology, and initial T- and N-stage.

Conclusion: The current finding of almost equal bone metastasis free survival and overall survival in patients with LA-NSCLC in RPA group 1 suggests a longer survival for patients who receive PCI, and thereby have a reduced risk of BM.

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Related in: MedlinePlus

Survival data of patients with locally advanced non-small cell lung cancer in recursive partitioning analysis group 1 treated with PCI. BMFS = Brain-metastasis free survival, OS = Overall survival, PFS = Progression free survival.
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Figure 1: Survival data of patients with locally advanced non-small cell lung cancer in recursive partitioning analysis group 1 treated with PCI. BMFS = Brain-metastasis free survival, OS = Overall survival, PFS = Progression free survival.

Mentions: At a median follow-up of 16.8 months (range: 7–18.6 months), 41 of the 62 patients with LA-NSCLC were alive at the time of analysis. Median survival for the entire population was 16.7 months (SE: 0.51; 95% CI: 15.7–17.7 months). As illustrated in Figure 1, the 1-year, and 18-month estimates of the OS were 86% and 62%, respectively. Six patients (9.7%) developed brain metastases at some time during the course of follow-up. Only one (2%) patient developed brain metastasis as the site of first failure. The median time to the development of brain metastases was 7 months (range, 5–13 months). Brain metastasis was the only site of recurrence in one of six patients. Among the other five patients with brain metastasis, local progression, liver metastasis, and adrenal metastasis developed asynchronously in four, two, and one patient, respectively. Median BMFS was 16.7 months (SE:0.51, 95% CI: 15.5–17.7 months). Two of the six patients with brain metastasis were alive at the time of analysis. As illustrated in Figure 1, BMFS rates at 1 year and 18 months were 92% and 90%, respectively.


Prophylactic cranial irradiation in locally advanced non-small cell lung cancer: outcome of recursive partitioning analysis group 1 patients.

Yavuz AA, Topkan E, Onal C, Yavuz MN - J. Exp. Clin. Cancer Res. (2008)

Survival data of patients with locally advanced non-small cell lung cancer in recursive partitioning analysis group 1 treated with PCI. BMFS = Brain-metastasis free survival, OS = Overall survival, PFS = Progression free survival.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2612647&req=5

Figure 1: Survival data of patients with locally advanced non-small cell lung cancer in recursive partitioning analysis group 1 treated with PCI. BMFS = Brain-metastasis free survival, OS = Overall survival, PFS = Progression free survival.
Mentions: At a median follow-up of 16.8 months (range: 7–18.6 months), 41 of the 62 patients with LA-NSCLC were alive at the time of analysis. Median survival for the entire population was 16.7 months (SE: 0.51; 95% CI: 15.7–17.7 months). As illustrated in Figure 1, the 1-year, and 18-month estimates of the OS were 86% and 62%, respectively. Six patients (9.7%) developed brain metastases at some time during the course of follow-up. Only one (2%) patient developed brain metastasis as the site of first failure. The median time to the development of brain metastases was 7 months (range, 5–13 months). Brain metastasis was the only site of recurrence in one of six patients. Among the other five patients with brain metastasis, local progression, liver metastasis, and adrenal metastasis developed asynchronously in four, two, and one patient, respectively. Median BMFS was 16.7 months (SE:0.51, 95% CI: 15.5–17.7 months). Two of the six patients with brain metastasis were alive at the time of analysis. As illustrated in Figure 1, BMFS rates at 1 year and 18 months were 92% and 90%, respectively.

Bottom Line: By univariate analysis, rates of BM were significantly higher in patients younger than 60 years of age (p = 0.03).Multivariate analysis showed no significant difference in BM-free survival according to gender, age, histology, and initial T- and N-stage.The current finding of almost equal bone metastasis free survival and overall survival in patients with LA-NSCLC in RPA group 1 suggests a longer survival for patients who receive PCI, and thereby have a reduced risk of BM.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Baskent University Medical Faculty, Adana Medical and Research Center, Kisla Saglik Yerleskesi, Adana, Turkey. ayavuz@baskent-adn.edu.tr

ABSTRACT

Background: Prophylactic cranial irradiation (PCI) has been demonstrated to reduce or delay the incidence of brain metastases (BM) in locally advanced non-small cell lung carcinoma (LA-NSCLC) patients with various prognostic groups. With this current cohort we planned to evaluate the potential usefulness of prophylactic cranial irradiation (PCI) specifically in recursive partitioning analysis (RPA) Group 1, which is the most favorable group of LA-NSCLC patients.

Methods: Between March 2007 and February 2008, 62 patients in RPA group 1 were treated with sequential chemoradiotherapy and PCI for stage IIIB NSCLC. The induction chemotherapy consisted of 3 courses of cisplatin (80 mg/m2) and docetaxel (80 mg/m2); each course was given every 21 days. Thoracic radiotherapy (TRT) was given at a dose of 60 Gy using 3-D conformal planning. All patients received a total dose of 30 Gy PCI (2 Gy/fr, 5 days a week), beginning on the first day of the TRT. Then, all patients received 3 further courses of the same chemotherapy protocol.

Results: Six (9.7%) patients developed brain metastases during their clinical course. Only one (2%) patient developed brain metastasis as the site of first treatment failure. Median brain metastasis-free survival, overall survival, and progression free survival were 16.6, 16.7, and 13.0 months, respectively. By univariate analysis, rates of BM were significantly higher in patients younger than 60 years of age (p = 0.03). Multivariate analysis showed no significant difference in BM-free survival according to gender, age, histology, and initial T- and N-stage.

Conclusion: The current finding of almost equal bone metastasis free survival and overall survival in patients with LA-NSCLC in RPA group 1 suggests a longer survival for patients who receive PCI, and thereby have a reduced risk of BM.

Show MeSH
Related in: MedlinePlus