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Original Article | Open Access

Extensive-stage small cell lung cancer: Is prophylactic cranial irradiation necessary in the era of immunotherapy with MRI surveillance?

Yuanhu Yao1 ( ), Nan Yao2, Zhaohui Qin3, Ji Ma2, Jiaying Lu2, Li Cui2, Wanxi Qu2, Shiwang Yuan2, Shaodong Tong4, Na Li5, Hao Li6
Department of Radiation Oncology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
Research Center for Medical and Health Emergency Rescue, Xuzhou Medical University, Xuzhou, Jiangsu, China
Department of Radiation Oncology, The Third People’s Hospital of Xuzhou, Xuzhou, Jiangsu, China
Department of Radiation Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
Department of Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
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Abstract

Objective

The role of prophylactic cranial irradiation (PCI) in treating extensive-stage small-cell lung cancer (ES-SCLC) has been controversial. This study aimed to comprehensively analyze the efficacy of PCI for the treatment of ES-SCLC under active brain magnetic resonance imaging (MRI) surveillance.

Methods

Patients with ES-SCLC with no brain metastases (BM) confirmed by MRI at the time of diagnosis who responded well to first-line chemoimmunotherapy at three general hospitals were retrospectively included. Overall survival (OS), progression-free survival (PFS), and cumulative incidence of BM were compared between patients who underwent PCI and those who did not.

Results

In total, 66 consecutive patients treated between March 2019 and December 2021 were included in our dataset. Seventeen patients underwent PCI (PCI group) and 49 patients did not (non-PCI group). In comparison with the non-PCI group, PCI did not provide OS (median OS: 18.53 vs. 17.35 months, p = 0.28) or PFS (median PFS: 8.61 vs. 7.56 months, p = 0.41) benefits. When death was counted as a competing risk, the difference in the cumulative incidence rate of BM was not statistically significant (1-year: 12.79% vs. 38.09%; p = 0.14).

Conclusion

Compared to active MRI surveillance, first-line chemoimmunotherapy followed by PCI did not improve the prognosis of patients with ES-SCLC. Further studies are warranted to evaluate the therapeutic effects of PCI following chemoimmunotherapy.

Keywords

immunotherapymagnetic resonance imagingbrain metastasesextensive-stage small cell lung cancerprophylactic cranial irradiation

References

1

Hochstenbag MM, Twijnstra A, Wilmink JT, Wouters EF, ten Velde GP. Asymptomatic brain metastases (BM) in small cell lung cancer (SCLC): MR-imaging is useful at initial diagnosis. J Neurooncol. 2000;48(3):243-248.
Crossref Google Scholar
2

Seute T, Leffers P, ten Velde GP, Twijnstra A. Detection of brain metastases from small cell lung cancer: consequences of changing imaging techniques (CT versus MRI). Cancer. 2008;112(8):1827-1834.
Crossref Google Scholar
3

Gazdar AF, Bunn PA, Minna JD. Small-cell lung cancer: what we know, what we need to know and the path forward. Nat Rev Cancer. 2017;17(12):725-737.
Crossref Google Scholar
4

Chen Y, Li J, Hu Y, et al. Prophylactic cranial irradiation could improve overall survival in patients with extensive small cell lung cancer: A retrospective study. Verbesserung der Gesamtüberlebenszeit durch prophylaktische kraniale Bestrahlung bei Patienten mit ausgedehntem kleinzelligem Bronchialkarzinom: Eine retrospektive Studie. Strahlenther Onkol. 2016;192(12):905-912.
Crossref Google Scholar
5

Kou P, Wang H, Yang D, Zhang Y, Yu J. Application of prophylactic cranial irradiation in limited-stage small-cell lung cancer: which patients could benefit? Future Oncol (London, England). 2019;15(1):3237-3245.
Crossref Google Scholar
6

Aupérin A, Arriagada R, Pignon JP, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med. 1999;341(7):476-484.
Crossref Google Scholar
7

Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. 2007;357(7):664-672.
Crossref Google Scholar
8

Takahashi T, Yamanaka T, Seto T, et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2017;18(5):663-671.
Crossref Google Scholar
9

Horn L, Mansfield AS, Szczęsna A, et al. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. N Engl J Med. 2018;379(23):2220-2229.
Crossref Google Scholar
10

Paz-Ares L, Dvorkin M, Chen Y, et al. Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet (London, England). 2019;394(10212):1929-1939.
Crossref Google Scholar
11

Goldman JW, Dvorkin M, Chen Y, et al. Durvalumab, with or without tremelimumab, plus platinum-etoposide versus platinum-etoposide alone in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): updated results from a randomised, controlled, open-label, phase 3 trial. Lancet Oncol. 2021;22(1):51-65.
Crossref Google Scholar
12

Micke P, Faldum A, Metz T, et al. Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer–what limits limited disease? Lung Cancer (Amsterdam, Netherlands). 2002;37(3):271-276.
Crossref Google Scholar
13

Cheng Y, Han L, Wu L, et al. Effect of First-Line Serplulimab vs Placebo Added to Chemotherapy on Survival in Patients With Extensive-Stage Small Cell Lung Cancer: The ASTRUM-005 Randomized Clinical Trial. JAMA. 2022;328(12):1223-1232.
Crossref Google Scholar
14

Wang J, Zhou C, Yao W, et al. Adebrelimab or placebo plus carboplatin and etoposide as first-line treatment for extensive-stage small-cell lung cancer (CAPSTONE-1): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2022;23(6):739-747.
Crossref Google Scholar
15

Higgins KA, Curran WJ, Jr., Liu SV, et al. Patterns of Disease Progression after Carboplatin/Etoposide + Atezolizumab in Extensive-Stage Small-Cell Lung Cancer (ES-SCLC). Int J Radiat Oncol, Biol, Phys. 2020;108(5):1398.
Crossref Google Scholar
16

Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after Chemoradiotherapy in Stage Ⅲ Non-Small-Cell Lung Cancer. N Engl J Med. 2017;377(20):1919-1929.
Crossref Google Scholar
17

Kamath SD, Kumthekar PU. Immune Checkpoint Inhibitors for the Treatment of Central Nervous System (CNS) Metastatic Disease. Front Oncol. 2018;8:414.
Crossref Google Scholar
18

Sun A, Bae K, Gore EM, et al. Phase Ⅲ trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer: neurocognitive and quality-of-life analysis. J Clin Oncol. 2011;29(3):279-286.
Crossref Google Scholar
19

Gondi V, Paulus R, Bruner DW, et al. Decline in tested and self-reported cognitive functioning after prophylactic cranial irradiation for lung cancer: pooled secondary analysis of Radiation Therapy Oncology Group randomized trials 0212 and 0214. Int J Radiat Oncol, Biol, Phys. 2013;86(4):656-664.
Crossref Google Scholar
20

Le Péchoux C, Laplanche A, Faivre-Finn C, et al. Clinical neurological outcome and quality of life among patients with limited small-cell cancer treated with two different doses of prophylactic cranial irradiation in the intergroup phase Ⅲ trial (PCI99-01, EORTC 22003-08004, RTOG 0212 and IFCT 99-01). Ann Oncol. 2011;22(5):1154-1163.
Crossref Google Scholar
Precision Radiation Oncology
Volume 7 Issue 2,
June 2023
Pages 111-117
DOI: 10.1002/pro6.1200
Cite this article:
Yao Y, Yao N, Qin Z, et al. Extensive-stage small cell lung cancer: Is prophylactic cranial irradiation necessary in the era of immunotherapy with MRI surveillance?. Precision Radiation Oncology, 2023, 7(2): 111-117. https://doi.org/10.1002/pro6.1200

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Received: 23 March 2023
Revised: 16 May 2023
Accepted: 17 May 2023
Published: 21 June 2023
© 2023 The Authors.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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