| Efficacy of Prophylactic Cranial Irradiation According to the Risk of Extracranial Recurrence in Limited-Stage Small Cell Lung Cancer |
Tae Hoon Lee1
, Joo-Hyun Chung1
, Hong-Gyun Wu1,2,3, Suzy Kim2,4, Joo Ho Lee1,2,3, Bhumsuk Keam3,5, Jin-Soo Kim6, Ki Hwan Kim6, Byoung Hyuck Kim2,3,4
, Hak Jae Kim1,2,3
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1Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
4Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
5Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
6Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Received: December 23, 2022; Accepted: February 20, 2023. Published online: February 24, 2023.
*Tae Hoon Lee and Joo-Hyun Chung contributed equally to this work. |
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| 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 0.243–0.931, 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. |
| Key words:
Small cell lung carcinoma, Brain metastases, Prophylactic cranial irradiation, Competing risk regression |
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