Is there a benefit to PCI in limited-stage SCLC?

  • Pezzi TA & al.
  • JAMA Netw Open
  • 01.04.2020

  • von Kelli Whitlock Burton
  • Studien – kurz & knapp
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Takeaway

  • Receiving prophylactic cranial irradiation (PCI) after thoracic radiation is not associated with decreased risk for brain metastases or improved OS in patients with limited-stage (LS) small-cell lung cancer (SCLC) whose disease is staged with MRI.

Why this matters

  • Although some national guidelines recommend PCI in some patients with SCLC, the recommendation is based on studies conducted before the use of MRI for staging became more routine.

Study design

  • 297 patients with LS-SCLC underwent thoracic radiation, followed by PCI (n=205) or not (n=92).
  • Propensity matching with 84 patient pairs.
  • Funding: None disclosed.

Key results

  • Median thoracic radiation treatment dose was 45.0 Gy in both groups.
  • Complete or partial response to radiation therapy was reported in 91.4% of the no-PCI and 94.9% of the PCI group.
  • After propensity matching, unadjusted incidence rate of brain metastases was higher in the no-PCI than the PCI group, but not significantly so (20.40% vs 11.20%; P=.10).
  • After multivariable analysis, PCI was not associated with a decreased risk for brain metastases (adjusted HR, 0.513; P=.09) or improved OS (adjusted HR, 0.787; P=.17).

Limitations

  • Single-center, retrospective study.