scholarly journals Current Patterns of Care for Patients with Extensive-Stage SCLC: Survey of U.S. Radiation Oncologists on Their Recommendations Regarding Prophylactic Cranial Irradiation

2016 ◽  
Vol 11 (8) ◽  
pp. 1305-1310 ◽  
Author(s):  
Aditya Jain ◽  
Jia Luo ◽  
Yiyi Chen ◽  
Mark A. Henderson ◽  
Charles R. Thomas ◽  
...  
Keyword(s):  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Patterns Of Care ◽  
Radiation Oncologists ◽  
Extensive Stage

Nationwide shift in patterns of prophylactic cranial irradiation utilization for extensive-stage small cell lung cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20099-e20099
Author(s):  
Olsi Gjyshi ◽  
Ethan B. Ludmir ◽  
Todd A. Pezzi ◽  
David Boyce-Fappiano ◽  
Timur Mitin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Practice Patterns ◽  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Phase Iii ◽  
Phase Iii Trial ◽  
Radiation Oncologists ◽  
Extensive Stage ◽  
Mri Surveillance ◽  
The Impact

e20099 Background: A recent phase III trial (Takahashi et al., 2017) showed no overall survival (OS) benefit in patients with extensive-stage small cell lung cancer (ES-SCLC) treated with prophylactic cranial irradiation (PCI), casting doubt on the practice of PCI as established in a prior phase III trial (Slotman et al., 2007). We undertook a nationwide survey of radiation oncologists to ascertain the impact of the Takahashi trial on the utilization of PCI for ES-SCLC patients. Methods: A total of 3,646 ASTRO-registered radiation oncologists in the United States were invited to answer an anonymous survey on their use of PCI in ES-SCLC, and the impact of the recent Takahashi et al. trial on their practice. The survey consisted of 35 questions created using a branching logic system via RedCAP. Results: A total of 438 (12%) radiation oncologists completed the survey. Responders were well-distributed across geographic regions, practice environment, age, gender, practice size and lung cancer volume. Most respondents (92%) were aware of the Takahashi trial. While 71% routinely offered PCI to ES-SCLC patients prior to the publication of this trial, only 43% continue to do so after its publication (p < 0.001). Most respondents (66%) had altered their practice in response to the study. There was no difference in post-publication practice patterns between academic and private practice radiation oncologists (43% vs. 44%, p = 0.81). While 43% of participants who were aware of the Takahashi trial still offered PCI after its publication, 82% of those unaware of the trial still continued to offer PCI (p < 0.001). Additionally, 25% of participants noted that they have experienced a decrease in medical oncology referrals for PCI for ES-SCLC patients. Twenty-two percent of participants stated that the Takahashi trial impacted their practice with regards to limited-stage SCLC patients as well. Looking toward the future, 47% of respondents reported that they would be willing to enroll both LS- and ES-SCLC patients on a randomized trial comparing active MRI-surveillance to PCI; 15% stated that they would enroll only LS-SCLC patients on such a trial, and 20% would enroll only ES-SCLC patients. Conclusions: The phase III data from Takahashi et al. (2017) has markedly impacted the current practice patterns in the US by reducing PCI utilization for ES-SCLC patients across all practice settings and measured demographic variables. Most respondents expressed openness to a randomized trial comparing active MRI surveillance to PCI for SCLC patients.

scholarly journals Role of Prophylactic Cranial Irradiation in Extensive-Stage Small Cell Lung Cancer

2021 ◽  
Vol 19 (12) ◽  
pp. 1465-1469
Author(s):  
Nathan Y. Yu ◽  
Terence T. Sio ◽  
Vinicius Ernani ◽  
Panayiotis Savvides ◽  
Steven E. Schild
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Small Cell ◽  
Developing Brain ◽  
Small Cell Lung ◽  
Extensive Stage

Patients with small cell lung cancer (SCLC) are at significant risk of developing brain metastases during their disease course. Prophylactic cranial irradiation (PCI) has been incorporated into SCLC treatment guidelines to diminish the risk of developing brain metastases. In 2007, a randomized trial suggested that PCI decreases the incidence of brain metastases and prolongs overall survival (OS) in patients with extensive-stage SCLC (ES-SCLC) who have responded to initial therapy. However, this study did not include modern central nervous system imaging with CT or MRI prior to randomization. A more recent Japanese trial with MRI staging and surveillance demonstrated that PCI diminished the incidence of brain metastases but did not improve survival. This review examines the largest clinical studies, controversies, and future directions of PCI in patients with ES-SCLC.

Should patients with extrapulmonary small cell carcinoma receive prophylactic cranial irradiation? An Irish experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2609-2609
Author(s):  
Jarushka Naidoo ◽  
Sandra Deady ◽  
Harry Comber ◽  
Paula Calvert
Keyword(s):  
Brain Metastases ◽  
Cell Carcinoma ◽  
Survival Data ◽  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Small Cell ◽  
Disease Biology ◽  
Stage Disease ◽  
Extensive Stage ◽  
Extrapulmonary Small Cell Carcinoma

2609 Background: Extrapulmonary small cell carcinoma (EPSCC) is a rare disease. Management is based on small cell lung carcinoma, and experience of disease biology on single institution studies. Prophylactic cranial irradiation (PCI) is not routinely administered in EPSCC. This study investigates the role of PCI in EPSCC, by analyzing the incidence, treatment and survival of patients with brain metastases in a national cohort. Secondary aims were to investigate disease biology and epidemiology. Methods: An audit was undertaken of patients diagnosed with primary EPSCC from the National Cancer Registry of Ireland, between 1995-2007. The number of patients who developed brain metastases, received cranial radiotherapy, and their survival data, were documented. Patient and disease characteristics, treatment, and survival data stratified by stage and primary site, were tabulated. Results: 280 patients were found. 141 (50.4%) patients were male, and 139 (49.6%) were female. 186 (66.4%) patients had extensive stage disease, 65 (23.2%) had limited stage disease, and in 29 (10.3%) patients the stage was not known. 17 patients (5.4%) developed brain metastases, 11 of which (64.7%) received cranial irradiation. These patients had a median progression-free survival (PFS) of 5.2 months, and a median overall survival (OS) of 10.2 months. The commonest primary sites were the oesophagus (n=43, 15.4%), cervix uteri (n=17, 6.0%), bladder (n=13, 4.6%) and prostate (n=10, 3.6%). There were 315 events of distant metastasis, and 21 local recurrence events. The commonest metastatic sites were the liver, 110 (34.9%), lymph nodes 58 (20.7%), lung 38 (12.1%), and bone 36 (12.8%). The median PFS and OS for limited stage EPSCC was 8.8 months and 14.9 months, and 1.5 months and 2.3 months for extensive stage EPSCC. Conclusions: Brain metastases were uncommon in this cohort (5.4%), and patients lived longer, suggesting a low rate of mortality from brain metastases. PCI is thus probably not warranted in EPSCC. Prospective data are necessary to support PCI in EPSCC. This is one of the largest datasets on EPSCC, providing insights into disease biology.

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