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

BMC Cancer

Research Article

Masato Karayama¹  Naoki Inui²  Kazunari Yamada³  Kazumasa Yasuda⁴  Shinya Sagisaka⁴  Koshi Yokomura⁵  Takashi Matsui⁵  Minako Omae⁵  Masato Kato⁵  Yuichi Ozawa⁵  Toshihiro Shirai⁶  Kazuhiro Asada⁶  Masato Fujii⁶  Yutaro Nakamura⁷  Takafumi Suda⁷ 

[1] Department of Clinical Oncology, 1-20-1 Handayama, Higashi Ward, 431-3192, Hamamatsu, Shizuoka, Japan;Department of Clinical Pharmacology and Therapeutics, 1-20-1 Handayama, Higashi Ward, 431-3192, Hamamatsu, Shizuoka, Japan;Department of Radiation Oncology, Seirei Mikatahara General Hospital, 3453 Mikatahara, Kita-ku, 433-8558, Hamamatsu, Shizuoka, Japan;Department of Respiratory Medicine, Iwata City Hospital, 512-3 Okubo, 438-0002, Iwata, Shizuoka, Japan;Department of Respiratory Medicine, Respiratory Disease Center, 3453 Mikatahara, Kita-ku, 433-8558, Hamamatsu, Shizuoka, Japan;Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-ku, 420-8527, Shizuoka, Shizuoka, Japan;Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, 431-3192, Hamamatsu, Shizuoka, Japan;

关键词: Small cell lung cancer;    Prophylactic cranial irradiation;    Stereotactic irradiation;    Magnetic resonance imaging;    Brain metastasis;   

DOI  :  10.1186/s12885-015-1593-2

 received in 2014-09-17, accepted in 2015-08-05,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundMagnetic 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.MethodsThe 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.ResultsOf 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).ConclusionPCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available.

【 授权许可】

CC BY   
© Ozawa et al. 2015