P090 Prevalence of Brain Metastases in Limited Stage Small Cell Lung Cancer Immediately Before Prophylactic Cranial Irradiation

7553 Background: Small cell lung cancer (SCLC) accounts for approximately 15% of new lung cancer diagnoses in the US and about one third of patients present with limited stage (LD-SCLC). Concurrent chemoradiotherapy followed by prophylactic cranial irradiation (PCI) is standard and produces long-term survival in up to 25% of good performance status (PS) patients. Some patients refuse or are ineligible for PCI resulting in poorer outcome. Topotecan is active against SCLC and crosses the blood brain barrier suggesting that it might reduce brain metastases in this group. This phase II trial was designed to explore that possibility. Methods: Eligible patients had declined or were ineligible for PCI after completing standard platinum etoposide chemotherapy with concurrent radiotherapy for LD-SCLC with at least a partial response (PR), had recovered from toxicity with PS 0–1, and had no evidence of brain metastases. Patients received 1.5 mg/m2/day topotecan IV for 5 consecutive days every 21 days for four cycles. Primary endpoint was incidence of brain metastases with secondary endpoints overall and progression-free survival and toxicity. Results: Twenty patients enrolled between November 1999 and May 2006. 17 patients (85%) completed 4 cycles of topotecan. Brain metastases developed in 6 patients (30%) at a mean of 5.3 months (range 84–324 days). Median survival was 25.9 months with median PFS 462 days. At final data analysis, eight patients (40%) were alive without evidence of disease at 19 to 92.6 months. Topotecan was well tolerated with grade 3/4 hematologic toxicity in 13 patients (65%) and neutropenic fever in 2 patients. One patient had radiation pneumonitis. One patient died with progressive disease and pneumonia after two cycles of topotecan. Conclusions: Adjuvant topotecan was well tolerated. The 30% rate of brain metastases suggests the possibility that topotecan was active in the brain. Overall and progression-free survivals are promising. Additional study of adjuvant topotecan in LD-SCLC patients who do not receive PCI may be warranted. No significant financial relationships to disclose.

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Limited-stage small-cell lung cancer: prophylactic cranial irradiation

Personalized Management of Lung Cancer ◽

10.2217/ebo.12.371 ◽

2013 ◽

pp. 130-140

Author(s):

Cecile Le Pechoux ◽

Hweej Al Mokhles

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Cranial Irradiation ◽

Prophylactic Cranial Irradiation ◽

Small Cell ◽

Small Cell Lung ◽

Limited Stage

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Prophylactic Cranial Irradiation for Patients With Locally Advanced Non–Small-Cell Lung Cancer at High Risk for Brain Metastases

Clinical Lung Cancer ◽

10.1016/j.cllc.2014.11.005 ◽

2015 ◽

Vol 16 (4) ◽

pp. 292-297 ◽

Cited By ~ 10

Author(s):

Henry S. Park ◽

Roy H. Decker ◽

Lynn D. Wilson ◽

James B. Yu

Keyword(s):

Lung Cancer ◽

High Risk ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Locally Advanced ◽

Cranial Irradiation ◽

Prophylactic Cranial Irradiation ◽

Small Cell ◽

Small Cell Lung

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

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2021.7105 ◽

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.

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