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Prophylactic Cranial Irradiation

Tyler P Robin, Timothy S Sannes, Feng-Ming Spring Kong, Francoise Mornex, Fred R Hirsch, Chad G Rusthoven, Laurie E Gaspar
INTRODUCTION: Guidelines have recommended prophylactic cranial irradiation (PCI) for patients with limited-stage small-cell lung cancer with at least a partial response after thoracic chemoradiation. However, the survival advantage has been small and was observed in an era before magnetic resonance imaging and surveillance. Neurotoxicity also remains a concern, especially in older adults. Thus, patients have a complex value-laden decision to make. We sought to better understand the role physicians play in patient decision making and introduce a patient decision aid (PDA) to potentially facilitate these discussions...
February 17, 2018: Clinical Lung Cancer
Patrizia Ciammella, Giorgia Timon, Alessio Bruni, Davide Franceschini, Paolo Borghetti, Nicolò Giaj-Levra, Carlo Greco, Vieri Scotti, Marco Trovo
INTRODUCTION: Radiation therapy plays an important role in the management of SCLC both in curative and palliative setting, however, conflicting data from clinical trials incite debate over the appropriate use of radiation therapy regarding prophylactic cranial irradiation (PCI) and/or thoracic consolidative in extensive-stage SCLC (ES-SCLC). This survey is conducted to evaluate the current pattern of care among Italian radiation oncologists. METHODS: In June 2016, all Italian radiation oncologists were invited to a web-based survey...
March 13, 2018: La Radiologia Medica
Macy Liu
No abstract text is available yet for this article.
February 2018: Translational Lung Cancer Research
Chi Hoon Maeng, Jae-Uk Song, Sung Ryul Shim, Jonghoo Lee
INTRODUCTION: The role of prophylactic cranial irradiation (PCI) is controversial in patients with extensive stage small cell lung cancer (ES-SCLC). The aim of this study was to determine the impact of PCI in these patients. METHODS: We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Central Register. The primary outcome was overall survival (OS)...
March 8, 2018: Journal of Thoracic Oncology
(no author information available yet)
BACKGROUND: Prophylactic cranial irradiation halves the rate of brain metastases in patients with small cell lung cancer. Individual randomized trials conducted on patients in complete remission were unable to clarify whether this treatment improves survival. OBJECTIVES: This study aims to test whether prophylactic cranial irradiation prolongs survival of patients with small cell lung cancer in complete remission. SEARCH METHODS: Published and unpublished trials were eligible...
February 6, 2018: Cochrane Database of Systematic Reviews
Ryoko Suzuki, Steven H Lin, Xiong Wei, Pamela K Allen, James W Welsh, Lauren A Byers, Ritsuko Komaki
BACKGROUND: We evaluated pretreatment total lymphocyte count (TLC, marker of immunosuppression), neutrophil-to-lymphocyte ratio (NLR, marker of inflammation), and overall survival (OS) in patients with extensive-stage small-cell lung cancer (ES-SCLC). METHODS: Pretreatment blood characteristics, age, sex, performance status, race, stage (M1a vs. M1b), number and location of metastases, weight loss, smoking status, chemotherapy cycles (<4 vs. ≥4), thoracic radiotherapy dose (<45 vs...
February 2, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Sonam Sharma, Matthew T McMillan, Abigail Doucette, Roger B Cohen, Abigail Berman, William Levin, Charles B Simone, Jacob Shabason
INTRODUCTION: Patients with small-cell lung cancer (SCLC) have a high incidence of occult brain metastases and are often treated with prophylactic cranial irradiation (PCI). Despite a small survival advantage in some studies, the role of PCI in extensive stage SCLC remains controversial. We used the National Cancer Database to assess survival of patients with metastatic SCLC treated with PCI. PATIENTS AND METHODS: Metastatic SCLC patients without brain metastases were identified...
December 14, 2017: Clinical Lung Cancer
(no author information available yet)
Since the beginning of 2017, Chinese Journal of Cancer has published a series of important questions in cancer research and clinical oncology, which spark diverse thoughts, interesting communications, and potential collaborations among researchers all over the world. In this article, 8 more questions are presented as follows. Question 86. In which circumstances is good supportive care associated with a survival advantage in patients with cancer? Question 87. Can we develop animal models to mimic immunotherapy response of cancer patients? Question 88...
January 22, 2018: Chinese Journal of Cancer
Yang Yang, Danhong Zhang, Xia Zhou, Wuan Bao, Yonglin Ji, Liming Sheng, Lei Cheng, Ying Chen, Xianghui Du, Guoqin Qiu
Background: The use of PCI in early operable patients with small cell lung cancer (SCLC) is still controversial. Therefore, we conducted a systematic review with meta-analysis to investigate the effects of PCI in resected SCLC patients. Methods: Relevant studies were identified from PubMed and EMBASE databases, the pooled hazard risks were obtained by the random-effects model. We also analyzed the brain metastasis (BM) risk in p-stage I patients without PCI. Results: Five retrospective studies were identified and a total of 1691 patients were included in our analysis, 315 of them received PCI...
2018: Journal of Cancer
Xiaozhen Liu, Tao Jiang, Wei Li, Xuefei Li, Chao Zhao, Jinpeng Shi, Sha Zhao, Yijun Jia, Meng Qiao, Limin Zhang, Jiawei Luo, Guanghui Gao, Fei Zhou, Fengying Wu, Xiaoxia Chen, Yayi He, Shengxiang Ren, Chunxia Su, Caicun Zhou
OBJECTIVES: Small-cell lung cancer (SCLC) has been viewed as a smoking-related disease, with only 2% to 5% patients being never-smokers. This study aimed to investigate the clinical characteristics of never-smoking and its association with treatment outcomes in Chinese SCLC patients in real world. METHODS: We performed a retrospective study of 303 patients with SCLC and grouped into smokers and never-smokers. The clinical characteristics and treatment outcomes of two groups were collected and compared...
January 2018: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Crystalrose Precival, Mickayla Landy, Claire Poole, Laura Mullaney
BACKGROUND: The use of prophylactic cranial irradiation (PCI) to treat brain metastases (BM) in non-small cell lung cancer (NSCLC) is restricted due to the potential associated toxicity and lack of survival benefit. BM can have a negative impact on neurocognitive function (NF) and quality of life (QOL). The aim of this review was to assess the impact of PCI on disease-specific and NF and QOL outcomes. MATERIALS AND METHODS: An electronic database literature search was completed to identify relevant studies...
January 2018: Anticancer Research
Ronald A M Damhuis, Suresh Senan, Jose S Belderbos
BACKGROUND: Prophylactic cranial irradiation (PCI) reduces the risk of overt brain metastases in patients with small-cell lung cancer (SCLC) and is currently recommended in guidelines for both limited and extensive disease. Given the concerns about the greater frequency of neurologic side effects in elderly patients, we studied the association among age, PCI usage, and survival for SCLC patients in the Netherlands. PATIENTS AND METHODS: Data from the Netherlands Cancer Registry for patients diagnosed with SCLC from 2009 to 2013 were queried...
March 2018: Clinical Lung Cancer
Benjamin H Lok, Jennifer Ma, Amanda Foster, Carmen A Perez, Weiji Shi, Zhigang Zhang, Bob T Li, Charles M Rudin, Andreas Rimner, Abraham J Wu
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...
October 2017: Advances in Radiation Oncology
Aparna H Kesarwala, Diana J Lu, Eric Xanthopoulos, Smith Apisarnthanarax, Keith A Cengel, Tracey L Evans, Charu Aggarwal, Roger B Cohen, Corey J Langer, Ramesh Rengan, Charles B Simone
INTRODUCTION: Prophylactic cranial irradiation (PCI) improves survival for small-cell lung cancer (SCLC). Evidence for PCI in limited-stage SCLC largely derives from studies requiring only chest x-ray (CXR) to determine remission status. We analyzed thoracic chemoradiation therapy (TCRT) outcomes according to imaging modality to determine which patients benefitted most from PCI. PATIENTS AND METHODS: All limited-stage SCLC patients who received TCRT as well as PCI at our institution were reviewed...
October 12, 2017: Clinical Lung Cancer
Dat Cao Pham, Ziad Awad, Bradford S Hoppe, Jason Hew, Ke Ning
Most extensive-stage small cell lung cancers have disseminated disease at diagnosis, and solitary adrenal metastasis from small cell lung cancer is rare. We report the case of a 51-year-old man with extensive-stage small cell lung cancer with solitary right adrenal metastasis (T2N0M1), who was cured with resection of primary tumor, chemotherapy (cisplatin, etoposide), adrenalectomy, consolidative thoracic radiotherapy, and prophylactic cranial irradiation. He remained cancer free, 7.5 years since diagnosis...
October 2017: Journal of Investigative Medicine High Impact Case Reports
Ting Martin Ma, Jimm Grimm, Riley McIntyre, Heather Anderson-Keightly, Lawrence R Kleinberg, Russell K Hales, Joseph Moore, Tracy Vannorsdall, Kristin J Redmond
BACKGROUND AND PURPOSE: To prospectively evaluate hippocampal radiation dose volume effects and memory decline following cranial irradiation. MATERIAL AND METHODS: Effects of hippocampal radiation over a wide range of doses were investigated by combining data from three prospective studies. In one, adults with small cell lung cancer received hippocampal-avoidance prophylactic cranial irradiation. In the other two, adults with glioblastoma multiforme received neural progenitor cell sparing radiation or no sparing with extra dose delivered to subventricular zone...
November 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
James J Urbanic
No abstract text is available yet for this article.
November 2017: Journal of Oncology Practice
Steven E Schild, Terence T Sio, Thomas B Daniels, Stephen G Chun, Dirk Rades
Small-cell lung cancer (SCLC) has a high predilection for metastasizing to the brain after chemotherapy. This has been blamed on the blood-brain barrier, which prevents chemotherapy from penetrating into the brain, thus creating a sanctuary site. It has been estimated that up to three quarters of patients with SCLC will eventually develop brain metastases. This led investigators to administer prophylactic cranial irradiation (PCI) to decrease this risk. Several trials were performed in patients with SCLC after initial therapy (chemotherapy with or without thoracic radiotherapy) that compared the outcomes of PCI versus no PCI...
November 2017: Journal of Oncology Practice
Angel Qin, Gregory P Kalemkerian
No abstract text is available yet for this article.
November 2017: Journal of Oncology Practice
Yoshiro Nakahara, Jiichiro Sasaki, Tomoya Fukui, Sakiko Otani, Satoshi Igawa, Kazushige Hayakawa, Noriyuki Masuda
Small-cell lung cancer (SCLC) has a particular propensity to metastasize to the brain, affecting ~10% of SCLC patients at diagnosis, but may occur in more than 50% of 2-year survivors. Most cytotoxic drugs have limited ability to cross the blood-brain barrier, and the effectiveness of chemotherapy for brain metastasis is limited. Therefore, prophylactic cranial irradiation (PCI) has been proposed to treat SCLC. A meta-analysis revealed that PCI significantly decreased the risk of brain metastasis and increased the 3-year survival rate; it has been established as a standard therapy for limited-disease SCLC...
October 25, 2017: Japanese Journal of Clinical Oncology
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