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Outcome and prognostic factors of multimodal therapy for pulmonary large-cell neuroendocrine carcinomas.

Rieber J, Schmitt J, Warth A, Muley T, Kappes J, Eichhorn F, Hoffmann H, Heussel CP, Welzel T, Debus J, Thomas M, Steins M, Rieken S - Eur. J. Med. Res. (2015)

Bottom Line: Patients with incomplete resection showed a survival benefit from adjuvant radiotherapy.The administration of adjuvant chemotherapy improved the general worse prognosis in higher pathologic stages.The low incidence of spontaneous brain metastases questions a possible role of PCI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. juliane.rieber@med.uni-heidelberg.de.

ABSTRACT

Background: There is controversy whether patients diagnosed with large-cell neuroendocrine carcinoma (LCNEC) should be treated according to protocols for non-small cell lung cancers (NSCLC) or small cell lung cancers (SCLC), especially with regard to the administration of prophylactic cranial irradiation (PCI). This study was set up to determine the incidence of brain metastases and to investigate the outcome following multimodal treatment in 70 patients with LCNEC.

Methods: Seventy patients with histologically confirmed LCNEC were treated at the University Hospital of Heidelberg between 2001 and 2014. Data were collected retrospectively. Al most all patients received thoracic surgery as initial treatment (94 %). Chemotherapy was administered in 32 patients as part of the initial treatment. Fourteen patients were treated with adjuvant or definitive thoracic radiotherapy according to NSCLC protocols. Cranial radiotherapy due to brain metastases, mostly given as whole brain radiotherapy (WBRT), was received by fourteen patients. Statistical analysis was performed using the long-rank test and the Kaplan-Meier method.

Results: Without PCI, the detected rate for brain metastases was 25 % after a median follow-up time of 23.4 months, which is comparable to NSCLC patients in general. Overall (OS), local (LPFS), brain metastases-free survival (BMFS) and extracranial distant progression-free survival (eDPFS) was 43, 50, 63 and 50 % at 5 years, respectively. Patients with incomplete resection showed a survival benefit from adjuvant radiotherapy. The administration of adjuvant chemotherapy improved the general worse prognosis in higher pathologic stages.

Conclusion: In LCNEC patients, the administration of radiotherapy according to NSCLC guidelines appears reasonable and contributes to acceptable results of multimodal treatment regimes. The low incidence of spontaneous brain metastases questions a possible role of PCI.

No MeSH data available.


Related in: MedlinePlus

Brain metastases-free survival (a) is significantly dependent on tumor stages (b) (p = 0.045).
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Fig2: Brain metastases-free survival (a) is significantly dependent on tumor stages (b) (p = 0.045).

Mentions: Seventeen patients (25 %) were diagnosed with brain metastases during follow-up. While 9 patients only suffered from 1 to 2 brain metastases, 8 patients presented with disseminated metastases (more than three). Patients presenting with 1–2 metastases either received surgical resection or radiosurgery. Hence, brain metastases-free survival was 85 % after 2 years and 63 % after 5 years (Fig. 2a). Brain metastases-free survival was not influenced by age and sex. Interestingly, the development of brain metastases was significantly associated with pathologic stage when comparing stage I vs. stage II–IV tumors (p = 0.045; Fig. 2b).Fig. 2


Outcome and prognostic factors of multimodal therapy for pulmonary large-cell neuroendocrine carcinomas.

Rieber J, Schmitt J, Warth A, Muley T, Kappes J, Eichhorn F, Hoffmann H, Heussel CP, Welzel T, Debus J, Thomas M, Steins M, Rieken S - Eur. J. Med. Res. (2015)

Brain metastases-free survival (a) is significantly dependent on tumor stages (b) (p = 0.045).
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536693&req=5

Fig2: Brain metastases-free survival (a) is significantly dependent on tumor stages (b) (p = 0.045).
Mentions: Seventeen patients (25 %) were diagnosed with brain metastases during follow-up. While 9 patients only suffered from 1 to 2 brain metastases, 8 patients presented with disseminated metastases (more than three). Patients presenting with 1–2 metastases either received surgical resection or radiosurgery. Hence, brain metastases-free survival was 85 % after 2 years and 63 % after 5 years (Fig. 2a). Brain metastases-free survival was not influenced by age and sex. Interestingly, the development of brain metastases was significantly associated with pathologic stage when comparing stage I vs. stage II–IV tumors (p = 0.045; Fig. 2b).Fig. 2

Bottom Line: Patients with incomplete resection showed a survival benefit from adjuvant radiotherapy.The administration of adjuvant chemotherapy improved the general worse prognosis in higher pathologic stages.The low incidence of spontaneous brain metastases questions a possible role of PCI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. juliane.rieber@med.uni-heidelberg.de.

ABSTRACT

Background: There is controversy whether patients diagnosed with large-cell neuroendocrine carcinoma (LCNEC) should be treated according to protocols for non-small cell lung cancers (NSCLC) or small cell lung cancers (SCLC), especially with regard to the administration of prophylactic cranial irradiation (PCI). This study was set up to determine the incidence of brain metastases and to investigate the outcome following multimodal treatment in 70 patients with LCNEC.

Methods: Seventy patients with histologically confirmed LCNEC were treated at the University Hospital of Heidelberg between 2001 and 2014. Data were collected retrospectively. Al most all patients received thoracic surgery as initial treatment (94 %). Chemotherapy was administered in 32 patients as part of the initial treatment. Fourteen patients were treated with adjuvant or definitive thoracic radiotherapy according to NSCLC protocols. Cranial radiotherapy due to brain metastases, mostly given as whole brain radiotherapy (WBRT), was received by fourteen patients. Statistical analysis was performed using the long-rank test and the Kaplan-Meier method.

Results: Without PCI, the detected rate for brain metastases was 25 % after a median follow-up time of 23.4 months, which is comparable to NSCLC patients in general. Overall (OS), local (LPFS), brain metastases-free survival (BMFS) and extracranial distant progression-free survival (eDPFS) was 43, 50, 63 and 50 % at 5 years, respectively. Patients with incomplete resection showed a survival benefit from adjuvant radiotherapy. The administration of adjuvant chemotherapy improved the general worse prognosis in higher pathologic stages.

Conclusion: In LCNEC patients, the administration of radiotherapy according to NSCLC guidelines appears reasonable and contributes to acceptable results of multimodal treatment regimes. The low incidence of spontaneous brain metastases questions a possible role of PCI.

No MeSH data available.


Related in: MedlinePlus