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Management of brain metastasis with magnetic resonance imaging and stereotactic irradiation attenuated benefits of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer.

Ozawa Y, Omae M, Fujii M, Matsui T, Kato M, Sagisaka S, Asada K, Karayama M, Shirai T, Yasuda K, Nakamura Y, Inui N, Yamada K, Yokomura K, Suda T - BMC Cancer (2015)

Bottom Line: Of 418 patients with SCLC, 124 met criteria and were divided into patients receiving PCI (PCI group; n = 29) and those without PCI (non-PCI groups; n = 95).Moreover, these factors did not significantly differ among patients with stage III disease (25 vs. 26 months; p = 0.680, 42.3 vs. 52.3%; p = 0.458, respectively).PCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Respiratory Disease Center, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan. u1.ozawa@sis.seirei.or.jp.

ABSTRACT

Background: Magnetic resonance imaging (MRI) enables a more sensitive detection of brain metastasis and stereotactic irradiation (SRI) efficiently controls brain metastasis. In limited-stage small cell lung cancer (LS-SCLC), prophylactic cranial irradiation (PCI) in patients with good responses to initial treatment is recommended based on the survival benefit shown in previous clinical trials. However, none of these trials evaluated PCI effects using the management of brain metastasis with MRI or SRI. This study aimed to determine the effects of MRI and SRI on the benefits of PCI in patients with LS-SCLC.

Methods: The clinical records of pathologically proven SCLC from January 2006 to June 2013 in facilities equipped with or had access to SRI in Japan were retrospectively reviewed. Patients with LS-SCLC and complete or good partial responses after initial treatment were included in the study and analyzed by the Kaplan-Meier method.

Results: Of 418 patients with SCLC, 124 met criteria and were divided into patients receiving PCI (PCI group; n = 29) and those without PCI (non-PCI groups; n = 95). At baseline, ratios of patients with stage III were significantly advantageous for the non-PCI group, although younger age and high ratios of complete response and MRI confirmed absence of brain metastasis were advantageous for the PCI group. Neither median survival times (25 vs. 34 months; p = 0.256) nor cumulative incidence of brain metastasis during 2 years (45.5 vs. 30.8%; p = 0.313) significantly differed between the two groups. Moreover, these factors did not significantly differ among patients with stage III disease (25 vs. 26 months; p = 0.680, 42.3 vs. 52.3%; p = 0.458, respectively).

Conclusion: PCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available.

No MeSH data available.


Related in: MedlinePlus

Prophylactic cranial irradiation (PCI) and overall survival of all patients (a) and of patients with stage III disease (b), M: months
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Fig1: Prophylactic cranial irradiation (PCI) and overall survival of all patients (a) and of patients with stage III disease (b), M: months

Mentions: Survival curves after the diagnosis of SCLC in 124 enrolled patients are shown in Fig. 1a. MSTs were 25 and 34 months in the PCI and non-PCI groups, revealing no significant difference between the groups (p = 0.256). To correct for differences in the disease stage, we only analyzed patients with stage III disease (Fig. 1b) and revealed similar survival curves and MSTs (25 vs. 26 months, respectively, p = 0.680). Curves for the cumulative occurrence of BM are shown in Fig. 2a and b. Among the 124 enrolled patients, BM developed at 2 years from diagnosis in 45.5 and 30.8 % in the PCI and non-PCI groups, respectively (p = 0.313). Similarly, among patients only with stage III disease, occurrence rates during 2 years were 42.3 and 52.3 % in the PCI and non-PCI groups, respectively, and did not significantly differ between the two groups (p = 0.458). Furthermore, we analyzed patients confirmed to not have BM with cranial MRI after initial treatment. The BM occurrence rates during 2 years were 43.0 and 38.4 % in the PCI and non-PCI groups, respectively (p = 0.865).Fig. 1


Management of brain metastasis with magnetic resonance imaging and stereotactic irradiation attenuated benefits of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer.

Ozawa Y, Omae M, Fujii M, Matsui T, Kato M, Sagisaka S, Asada K, Karayama M, Shirai T, Yasuda K, Nakamura Y, Inui N, Yamada K, Yokomura K, Suda T - BMC Cancer (2015)

Prophylactic cranial irradiation (PCI) and overall survival of all patients (a) and of patients with stage III disease (b), M: months
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4537586&req=5

Fig1: Prophylactic cranial irradiation (PCI) and overall survival of all patients (a) and of patients with stage III disease (b), M: months
Mentions: Survival curves after the diagnosis of SCLC in 124 enrolled patients are shown in Fig. 1a. MSTs were 25 and 34 months in the PCI and non-PCI groups, revealing no significant difference between the groups (p = 0.256). To correct for differences in the disease stage, we only analyzed patients with stage III disease (Fig. 1b) and revealed similar survival curves and MSTs (25 vs. 26 months, respectively, p = 0.680). Curves for the cumulative occurrence of BM are shown in Fig. 2a and b. Among the 124 enrolled patients, BM developed at 2 years from diagnosis in 45.5 and 30.8 % in the PCI and non-PCI groups, respectively (p = 0.313). Similarly, among patients only with stage III disease, occurrence rates during 2 years were 42.3 and 52.3 % in the PCI and non-PCI groups, respectively, and did not significantly differ between the two groups (p = 0.458). Furthermore, we analyzed patients confirmed to not have BM with cranial MRI after initial treatment. The BM occurrence rates during 2 years were 43.0 and 38.4 % in the PCI and non-PCI groups, respectively (p = 0.865).Fig. 1

Bottom Line: Of 418 patients with SCLC, 124 met criteria and were divided into patients receiving PCI (PCI group; n = 29) and those without PCI (non-PCI groups; n = 95).Moreover, these factors did not significantly differ among patients with stage III disease (25 vs. 26 months; p = 0.680, 42.3 vs. 52.3%; p = 0.458, respectively).PCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Respiratory Disease Center, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan. u1.ozawa@sis.seirei.or.jp.

ABSTRACT

Background: Magnetic resonance imaging (MRI) enables a more sensitive detection of brain metastasis and stereotactic irradiation (SRI) efficiently controls brain metastasis. In limited-stage small cell lung cancer (LS-SCLC), prophylactic cranial irradiation (PCI) in patients with good responses to initial treatment is recommended based on the survival benefit shown in previous clinical trials. However, none of these trials evaluated PCI effects using the management of brain metastasis with MRI or SRI. This study aimed to determine the effects of MRI and SRI on the benefits of PCI in patients with LS-SCLC.

Methods: The clinical records of pathologically proven SCLC from January 2006 to June 2013 in facilities equipped with or had access to SRI in Japan were retrospectively reviewed. Patients with LS-SCLC and complete or good partial responses after initial treatment were included in the study and analyzed by the Kaplan-Meier method.

Results: Of 418 patients with SCLC, 124 met criteria and were divided into patients receiving PCI (PCI group; n = 29) and those without PCI (non-PCI groups; n = 95). At baseline, ratios of patients with stage III were significantly advantageous for the non-PCI group, although younger age and high ratios of complete response and MRI confirmed absence of brain metastasis were advantageous for the PCI group. Neither median survival times (25 vs. 34 months; p = 0.256) nor cumulative incidence of brain metastasis during 2 years (45.5 vs. 30.8%; p = 0.313) significantly differed between the two groups. Moreover, these factors did not significantly differ among patients with stage III disease (25 vs. 26 months; p = 0.680, 42.3 vs. 52.3%; p = 0.458, respectively).

Conclusion: PCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available.

No MeSH data available.


Related in: MedlinePlus