Factors influencing the utilization of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer Journal Article


Authors: Lok, B. H.; Ma, J.; Foster, A.; Perez, C. A.; Shi, W.; Zhang, Z.; Li, B. T.; Rudin, C. M.; Rimner, A.; Wu, A. J.
Article Title: Factors influencing the utilization of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer
Abstract: Purpose Brain metastases are common in patients with limited-stage small cell lung cancer (LS-SCLC) due to the inability of most chemotherapeutics to penetrate the blood–brain barrier. Prophylactic cranial irradiation (PCI) is therefore recommended for use in patients with a good response to concurrent chemoradiotherapy. However, PCI is not always delivered; therefore, we investigated the reasons for PCI omission in patients who underwent therapy with curative intent. Methods and materials We retrospectively reviewed all patients with LS-SCLC who were treated with curative intent at our institution. Overall survival and cumulative incidence of brain metastasis were estimated by the Kaplan-Meier method. The Pearson χ2 test and Mann-Whitney U test were used to examine factors associated with PCI use, and prognostic factors were analyzed with Cox proportional hazards modeling. Results We examined 208 patients who were treated for LS-SCLC at our institution. A total of 115 patients (55%) received PCI. The most common documented reason for PCI omission was patient refusal due to neurotoxicity concerns (38%). Physician assessment of being medically unfit (33%) and of advanced age (8%) were the second and third most common reasons, respectively. Karnofsky performance status and clinical American Joint Committee on Cancer stage but not PCI were significantly associated with overall survival. Only clinical stage remained an independent factor on multivariate analysis. Conclusions Approximately half of patients with LS-SCLC ultimately receive PCI, generally for guideline-recommended reasons. The most common reason for PCI omission was patient concerns regarding neurotoxicity. Efforts to decrease PCI neurotoxicity, including hippocampal-sparing radiation and memantine use, may increase the use of this survival-improving intervention in eligible patients with LS-SCLC. © 2017 The Authors
Keywords: adult; aged; major clinical study; overall survival; cancer staging; neurotoxicity; cancer prevention; incidence; cohort analysis; patient assessment; retrospective study; skull irradiation; health care utilization; karnofsky performance status; brain metastasis; aging; general practitioner; small cell lung cancer; cancer prognosis; human; male; female; priority journal; article
Journal Title: Advances in Radiation Oncology
Volume: 2
Issue: 4
ISSN: 2452-1094
Publisher: Elsevier Inc.  
Date Published: 2017-10-01
Start Page: 548
End Page: 554
Language: English
DOI: 10.1016/j.adro.2017.08.001
PROVIDER: scopus
PMCID: PMC5707415
PUBMED: 29204521
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Zhigang Zhang
    250 Zhang
  2. Weiji Shi
    117 Shi
  3. Andreas Rimner
    272 Rimner
  4. Abraham Jing-Ching Wu
    209 Wu
  5. Benjamin H Lok
    55 Lok
  6. Amanda Foster
    62 Foster
  7. Jennifer Ma
    34 Ma
  8. Charles Rudin
    180 Rudin
  9. Bob Tingkan Li
    74 Li