Abraham J Wu1, Andrea Gillis2, Amanda Foster2, Kaitlin Woo3, Zhigang Zhang3, Daphna Y Gelblum2, Robert J Downey4, Kenneth E Rosenzweig5, Leonard Ong6, Carmen A Perez2, M Catherine Pietanza7, Lee Krug7, Charles M Rudin7, Andreas Rimner2. 1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States. Electronic address: wua@mskcc.org. 2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States. 4. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States. 5. Department of Radiation Oncology, Mount Sinai Medical Center, New York, United States. 6. Department of Nuclear Medicine, Memorial Sloan Kettering Cancer Center, New York, United States. 7. Department of Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, United States.
Abstract
BACKGROUND AND PURPOSE: The relationship between tumor-node-metastasis (TNM) stage and patterns of failure in limited-stage small cell lung cancer (LS-SCLC) remains unclear. We hypothesized that TNM stage predicts brain metastasis risk, and could inform the use of prophylactic cranial irradiation. MATERIAL AND METHODS: We reviewed 283 patients with stage I-IIIB SCLC. Competing-risks regression was used to analyze local, distant, and brain failure. Multivariate analysis was used to evaluate the effect of treatment and clinical factors on failure and OS. RESULTS: Patients with stage I or II SCLC (35% of cohort) had significantly better survival and lower risk of distant and brain metastasis, compared with stage III patients. The 5-year cumulative incidence of brain metastasis for stage I/II and III were 12% and 26%, respectively. Stage had no correlation with local failure. On multivariate analysis, stage was independently prognostic for survival, distant metastasis risk, and brain metastasis risk. CONCLUSIONS: TNM staging predicts likelihood of distant metastasis, brain metastasis, and survival in LS-SCLC. This supports the routine use of TNM staging in clinical practice. The lower risk of brain metastasis in stage I and II SCLC suggests that prophylactic cranial irradiation could play a more limited role in treatment of early-stage disease.
BACKGROUND AND PURPOSE: The relationship between tumor-node-metastasis (TNM) stage and patterns of failure in limited-stage small cell lung cancer (LS-SCLC) remains unclear. We hypothesized that TNM stage predicts brain metastasis risk, and could inform the use of prophylactic cranial irradiation. MATERIAL AND METHODS: We reviewed 283 patients with stage I-IIIB SCLC. Competing-risks regression was used to analyze local, distant, and brain failure. Multivariate analysis was used to evaluate the effect of treatment and clinical factors on failure and OS. RESULTS:Patients with stage I or II SCLC (35% of cohort) had significantly better survival and lower risk of distant and brain metastasis, compared with stage III patients. The 5-year cumulative incidence of brain metastasis for stage I/II and III were 12% and 26%, respectively. Stage had no correlation with local failure. On multivariate analysis, stage was independently prognostic for survival, distant metastasis risk, and brain metastasis risk. CONCLUSIONS: TNM staging predicts likelihood of distant metastasis, brain metastasis, and survival in LS-SCLC. This supports the routine use of TNM staging in clinical practice. The lower risk of brain metastasis in stage I and II SCLC suggests that prophylactic cranial irradiation could play a more limited role in treatment of early-stage disease.
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