C Le Péchoux1, A Laplanche2, C Faivre-Finn3, T Ciuleanu4, R Wanders5, D Lerouge6, R Keus7, M Hatton8, G M Videtic9, S Senan10, A Wolfson11, R Jones12, R Arriagada13, E Quoix14, A Dunant2. 1. Radiation Oncology Department. Electronic address: lepechoux@igr.fr. 2. Biostatistics and Epidemiology Unit, Institut Gustave-Roussy, Villejuif, France. 3. Department of Clinical Oncology, The Christie, Manchester, UK. 4. Medical Oncology Department, Institutul Oncologic I. Chiricuta, Cluj-Napoca, Romania. 5. Radiation Oncology Department, MAASTRO Clinic, Maastricht, The Netherlands. 6. Radiation Oncology Department, Centre François Baclesse, Caen, France. 7. Radiation Oncology Department, Arnhem's Radiotherapeutisch Instituut, Arnhem, The Netherlands. 8. Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK. 9. Radiation Oncology Department, Cleveland Clinic Foundation, Cleveland, USA. 10. Radiation Oncology Department, VU University Medical Centre, Amsterdam, The Netherlands. 11. Radiation Oncology Department, University of Miami School of Medicine, Miami, USA. 12. Department of Clinical Oncology, Beatson Oncology Centre, Glasgow, UK. 13. Radiation Oncology Department, Karolinska Institutet, Stockholm, Sweden. 14. Department of Pneumology, Hôpital Lyautey, Strasbourg, France.
Abstract
BACKGROUND: We recently published the results of the PCI99 randomised trial comparing the effect of a prophylactic cranial irradiation (PCI) at 25 or 36 Gy on the incidence of brain metastases (BM) in 720 patients with limited small-cell lung cancer (SCLC). As concerns about neurotoxicity were a major issue surrounding PCI, we report here midterm and long-term repeated evaluation of neurocognitive functions and quality of life (QoL). PATIENTS AND METHODS: At predetermined intervals, the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and brain module were used for self-reported patient data, whereas the EORTC-Radiation Therapy Oncology Group Late Effects Normal Tissue-Subjective, Objective, Management, Analytic scale was used for clinicians' assessment. For each scale, the unfavourable status was analysed with a logistic model including age, grade at baseline, time and PCI dose. RESULTS: Over the 3 years studied, there was no significant difference between the two groups in any of the 17 selected items assessing QoL and neurological and cognitive functions. We observed in both groups a mild deterioration across time of communication deficit, weakness of legs, intellectual deficit and memory (all P < 0.005). CONCLUSION: Patients should be informed of these potential adverse effects, as well as the benefit of PCI on survival and BM. PCI with a total dose of 25 Gy remains the standard of care in limited-stage SCLC.
RCT Entities:
BACKGROUND: We recently published the results of the PCI99 randomised trial comparing the effect of a prophylactic cranial irradiation (PCI) at 25 or 36 Gy on the incidence of brain metastases (BM) in 720 patients with limited small-cell lung cancer (SCLC). As concerns about neurotoxicity were a major issue surrounding PCI, we report here midterm and long-term repeated evaluation of neurocognitive functions and quality of life (QoL). PATIENTS AND METHODS: At predetermined intervals, the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and brain module were used for self-reported patient data, whereas the EORTC-Radiation Therapy Oncology Group Late Effects Normal Tissue-Subjective, Objective, Management, Analytic scale was used for clinicians' assessment. For each scale, the unfavourable status was analysed with a logistic model including age, grade at baseline, time and PCI dose. RESULTS: Over the 3 years studied, there was no significant difference between the two groups in any of the 17 selected items assessing QoL and neurological and cognitive functions. We observed in both groups a mild deterioration across time of communication deficit, weakness of legs, intellectual deficit and memory (all P < 0.005). CONCLUSION:Patients should be informed of these potential adverse effects, as well as the benefit of PCI on survival and BM. PCI with a total dose of 25 Gy remains the standard of care in limited-stage SCLC.
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