Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer Patients: Secondary Findings From the Prospective Randomized Phase 3 CONVERT Trial |
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Authors: | Antonin Levy Cécile Le Péchoux Hitesh Mistry Isabelle Martel-Lafay Andrea Bezjak Delphine Lerouge Laetitia Padovani Paul Taylor Corinne Faivre-Finn |
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Institution: | 1. Department of Radiation Oncology, Institut d’Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France;2. Univ Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France;3. INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France;4. Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom;5. Department of Radiation Oncology, Centre Léon-Bérard, Lyon, France;6. Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada;7. Department of Radiation Oncology, François Baclesse Cancer Center, Caen, France;8. Department of Radiation Oncology, Hôpital La Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France;9. The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom |
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Abstract: | IntroductionThe impact of the dose and fractionation of thoracic radiotherapy on the risk of developing brain metastasis (BM) has not been evaluated prospectively in limited stage SCLC patients receiving prophylactic cerebral irradiation (PCI).MethodsData from patients treated with PCI from the CONVERT trial were analyzed.ResultsFour hundred forty-nine of 547 patients (82%) received PCI after completion of chemoradiotherapy. Baseline brain imaging consisted of computed tomographic scans in 356 of 449 patients (79%) and magnetic resonance imaging in 83 of 449 (18%) patients. PCI was delivered to 220 of 273 participants (81%) in the twice-daily (BD) group and 229 of 270 in the once-daily (OD) group (85%; p = 0.49). Total median PCI dose was 25 Gy in both the BD and OD groups (p = 0.74). In patients who received PCI, 75 (17%) developed BM (35 8%] in OD and 40 9%] in BD) and 173 (39%) other extracranial progression. In the univariate analysis, gross tumor volume (GTV) was associated with an increased risk of BM (p = 0.007) or other radiological progression events (p = 0.006), whereas in a multivariate analysis both thoracic GTV (tGTV) and ECOG performance score were associated with either progression type. The median overall survival (OS) of patients treated with PCI was 29 months. In the univariate analysis of OS, PCI timing from end of chemotherapy, weight loss of more than 10%, and tGTV were prognostic factors associated with OS. In the multivariate analysis, only tGTV was associated with OS. Delay between end of chemotherapy and PCI was not associated with OS.ConclusionsPatients receiving OD or BD thoracic radiotherapy have the same risk of developing BM. Larger tumors are associated with a higher risk of BM. |
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Keywords: | Cranial irradiation Lung cancer Phase III trial |
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