@article{JTD22686,
author = {Daniel E. Oliver and Olivia G. Donnelly and G. Daniel Grass and Arash O. Naghavi and George Q. Yang and Thomas J. Dilling and Bradford A. Perez},
title = {Extracranial metastatic burden in extensive-stage small cell lung cancer: implications for prophylactic cranial irradiation},
journal = {Journal of Thoracic Disease},
volume = {10},
number = {7},
year = {2018},
keywords = {},
abstract = {Background: Patients with extensive-stage small cell lung cancer (ES-SCLC) often develop brain metastases. There is significant controversy regarding the benefit of prophylactic cranial irradiation (PCI) for patients with ES-SCLC. Our objective is to identify ES-SCLC patients who might be most likely to benefit from PCI.
Methods: We retrospectively reviewed 173 patients with ES-SCLC treated between 2010–2015. Of these, 117 patients were initially diagnosed without brain metastases and received systemic chemotherapy. Following exclusion of patients who received PCI and less than 2 cycles of platinum doublet therapy, 93 patients remained. Patient records were reviewed for clinical and radiographic features previously identified as relevant risk factors. Primary outcome was brain metastasis-free survival (BMFS). Kaplan-Meier analysis, log-rank tests and Cox multivariate models were used to compare outcomes.
Results: Median follow-up was 10.7 months (range, 3–58 months). Thirty-eight (40.9%) patients developed brain metastases. Three or more metastatic sites was associated with inferior BMFS on univariable (1-year estimate 43.8% vs. 61.3%; P=0.020) and multivariable (MVA) analysis [hazard ratio (HR) 2.33, 95% CI: 1.08–5.01; P=0.03).
Conclusions: Our results suggest that extracranial metastatic burden is associated with an increased risk for brain metastases in patients with ES-SCLC. As there is no clear standard regarding delivery of PCI in this patient population, utilizing the number of metastatic disease sites as a clinical indicator may help to improve selection of patients who benefit from PCI.},
issn = {2077-6624}, url = {https://jtd.amegroups.org/article/view/22686}
}