The impact of prophylactic cranial irradiation and consolidative thoracic radiation therapy for extensive stage small-cell lung cancer in the transition to the chemo-immunotherapy era: A single institution series

Authors

Andrew J. Gross, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH.
Saad Sheikh, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH.
Michael Kharouta, Advocate Aurora HealthFollow
Kevin Chaung, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH.
Serah Choi, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH.
Seunghee Margevicius, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH.
Pingfu Fu, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH.
Mitchell Machtay, Department of Radiation Oncology, Penn State College of Medicine, Hershey, PA.
Debora S. Bruno, Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH; Case Western School of Medicine, Cleveland, OH.
Afshin Dowlati, Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH; Case Western School of Medicine, Cleveland, OH.
Tithi Biswas, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH; Case Western School of Medicine, Cleveland, OH. Electronic address: tithipodder@gmail.com.

Recommended Citation

Gross AJ, Sheikh S, Kharouta M, et al. The Impact of Prophylactic Cranial Irradiation and Consolidative Thoracic Radiation Therapy for Extensive Stage Small-Cell Lung Cancer in the Transition to the Chemo-Immunotherapy Era: A Single Institution Series. Clin Lung Cancer. 2023;24(8):696-705. doi:10.1016/j.cllc.2023.08.009

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Introduction:Extensive-stage small-cell lung cancer (ES-SCLC) continues to have poor survival due to its aggressive behavior, despite improvements with incorporation of immunotherapy with standard chemotherapy. Controversy exists regarding the role of consolidative thoracic radiation therapy (TRT) and prophylactic cranial irradiation (PCI) in ES-SCLC due to high recurrence rates. We report our institutional result of the benefit of PCI and TRT in ES-SCLC.

Methods:Patients with ES-SCLC without intracranial metastasis at diagnosis (N = 163) were included. All patients completed systemic therapy with or without immunotherapy based on time of standard of care. Cohorts were divided by systemic therapy use and further subdivided by treatment with PCI and TRT. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method with log-rank test for comparison. The effects of TRT and PCI were estimated by multivariable (MVA) Cox regression.

Results:Seventy-four patients (45.4%) received TRT, and 33.1% (n = 54) received PCI. The median follow-up was 11 months (3-85 months). PCI improved median OS to 15 months from 10 months, P = .02) and median PFS to 8.5 months from 5 months (P = .02) which remained significant on MVA, P = .02 and P = .02, respectively. TRT improved OS on UVA (P = 0.002) but was not significant on MVA. TRT did not improve PFS.

Conclusion:This study including chemotherapy and chemo-immunotherapy suggests improved outcomes with addition of PCI in patients with ES-SCLC while TRT did not show benefit to either OS or PFS. A future trial is needed to evaluate the role of TRT and PCI in the era of chemo-immunotherapy.

Document Type

Article

PubMed ID

37993218