Chukwuka Eze1, Olarn Roengvoraphoj1, Maximilian Niyazi1, Guido Hildebrandt2, Rainer Fietkau3, Claus Belka4, Farkhad Manapov5. 1. Department of Radiation Oncology, LMU Munich, Munich, Germany. 2. Department of Radiation Oncology, University of Rostock, Rostock, Germany. 3. Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany. 4. Department of Radiation Oncology, LMU Munich, Munich, Germany; Comprehensive Pneumology Center, The German Center for Lung Research, Munich, Germany. 5. Department of Radiation Oncology, LMU Munich, Munich, Germany. Electronic address: Farkhad.Manapov@med.uni-muenchen.de.
Abstract
INTRODUCTION: Prophylactic cranial irradiation (PCI) has proven to decrease the incidence of brain metastases (BMs), with a modest improvement in survival. PATIENTS AND METHODS: The impact of PCI was evaluated in 184 patients treated with chemoradiotherapy. PCI was applied to patients with disease with partial and complete response only when cranial magnetic resonance imaging before and after primary treatment revealed no BMs. Correlation between PCI and overall survival (OS), BM-free survival (BMFS), and time to progression (TTP) was analyzed to describe survival within subgroups. RESULTS: Concurrent and sequential chemoradiotherapy was applied in 71 patients (39%) and 113 patients (61%), respectively. Seventy-one patients (39%) with partial and complete response were treated with PCI. Metachronous BMs were detected in 16 (23%) of 71 patients in the PCI group compared to 42 (37%) of 113 patients in the non-PCI group. Median BMFS in the PCI group was not reached; it was 23.6 months in the non-PCI group. Median OS and TTP were 26 months (range, 19.4-32.6 months) in the PCI group versus 14 months (range, 11.4-16.6 months) in patients without PCI whose disease responded to therapy versus 9 months in patients with disease that did not respond to therapy (P < .0001), and 27 versus 14.5 months (range, 9.0-19.9 months) versus 8.8 months (range, 7.7-9.9 months) (P < .0001) in the PCI group versus those with response without PCI versus those with nonresponse. The effect of PCI was independent of gender. On multivariate analysis, PCI was a variable correlating with OS (hazard ratio = 1.899; 95% confidence interval, 1.370-2.632; P < .0001) and TTP (hazard ratio = 2.164; 95% confidence interval, 1.371-3.415; P = .001) after adjustment for other prognostic factors. CONCLUSION: In real-life patients comprehensively staged with cranial magnetic resonance imaging, treatment response and PCI strongly correlated with prolonged OS, TTP, and BMFS.
INTRODUCTION: Prophylactic cranial irradiation (PCI) has proven to decrease the incidence of brain metastases (BMs), with a modest improvement in survival. PATIENTS AND METHODS: The impact of PCI was evaluated in 184 patients treated with chemoradiotherapy. PCI was applied to patients with disease with partial and complete response only when cranial magnetic resonance imaging before and after primary treatment revealed no BMs. Correlation between PCI and overall survival (OS), BM-free survival (BMFS), and time to progression (TTP) was analyzed to describe survival within subgroups. RESULTS: Concurrent and sequential chemoradiotherapy was applied in 71 patients (39%) and 113 patients (61%), respectively. Seventy-one patients (39%) with partial and complete response were treated with PCI. Metachronous BMs were detected in 16 (23%) of 71 patients in the PCI group compared to 42 (37%) of 113 patients in the non-PCI group. Median BMFS in the PCI group was not reached; it was 23.6 months in the non-PCI group. Median OS and TTP were 26 months (range, 19.4-32.6 months) in the PCI group versus 14 months (range, 11.4-16.6 months) in patients without PCI whose disease responded to therapy versus 9 months in patients with disease that did not respond to therapy (P < .0001), and 27 versus 14.5 months (range, 9.0-19.9 months) versus 8.8 months (range, 7.7-9.9 months) (P < .0001) in the PCI group versus those with response without PCI versus those with nonresponse. The effect of PCI was independent of gender. On multivariate analysis, PCI was a variable correlating with OS (hazard ratio = 1.899; 95% confidence interval, 1.370-2.632; P < .0001) and TTP (hazard ratio = 2.164; 95% confidence interval, 1.371-3.415; P = .001) after adjustment for other prognostic factors. CONCLUSION: In real-life patients comprehensively staged with cranial magnetic resonance imaging, treatment response and PCI strongly correlated with prolonged OS, TTP, and BMFS.
Authors: Mathijs L Tomassen; Jacquelien Pomp; Janneke van der Stap; Anne S R van Lindert; Max Peters; José S A Belderbos; Dirk K M De Ruysscher; Steven H Lin; Joost J C Verhoeff; Peter S N van Rossum Journal: Clin Transl Radiat Oncol Date: 2022-02-17
Authors: Cristina Pangua; Jacobo Rogado; Gloria Serrano-Montero; José Belda-Sanchís; Beatriz Álvarez Rodríguez; Laura Torrado; Nuria Rodríguez De Dios; Xabier Mielgo-Rubio; Juan Carlos Trujillo; Felipe Couñago Journal: World J Clin Oncol Date: 2022-06-24