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Extracranial metastatic burden in extensive-stage small cell lung cancer: implications for prophylactic cranial irradiation.
- Source :
-
Journal of thoracic disease [J Thorac Dis] 2018 Jul; Vol. 10 (7), pp. 4321-4327. - Publication Year :
- 2018
-
Abstract
- Background: Patients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI.<br />Methods: We retrospectively reviewed 173 patients with ES-SCLC treated between 2010-2015. Of these, 117 patients were initially diagnosed without brain metastases and received systemic chemotherapy. Following exclusion of patients who received PCI and less than 2 cycles of platinum doublet therapy, 93 patients remained. Patient records were reviewed for clinical and radiographic features previously identified as relevant risk factors. Primary outcome was brain metastasis-free survival (BMFS). Kaplan-Meier analysis, log-rank tests and Cox multivariate models were used to compare outcomes.<br />Results: Median follow-up was 10.7 months (range, 3-58 months). Thirty-eight (40.9%) patients developed brain metastases. Three or more metastatic sites was associated with inferior BMFS on univariable (1-year estimate 43.8% vs. 61.3%; P=0.020) and multivariable (MVA) analysis [hazard ratio (HR) 2.33, 95% CI: 1.08-5.01; P=0.03).<br />Conclusions: Our results suggest that extracranial metastatic burden is associated with an increased risk for brain metastases in patients with ES-SCLC. As there is no clear standard regarding delivery of PCI in this patient population, utilizing the number of metastatic disease sites as a clinical indicator may help to improve selection of patients who benefit from PCI.<br />Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
Details
- Language :
- English
- ISSN :
- 2072-1439
- Volume :
- 10
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of thoracic disease
- Publication Type :
- Academic Journal
- Accession number :
- 30174879
- Full Text :
- https://doi.org/10.21037/jtd.2018.06.92