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    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
    Levy, A
    Le Pechoux, C
    Mistry, Hitesh
    Martel-Lafay, I
    Bezjak, A
    Lerouge, D
    Padovani, L
    Taylor, Paul
    Faivre-Finn, Corinne
    Affiliation
    Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif
    Issue Date
    2019
    
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    Abstract
    INTRODUCTION: The 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). METHODS: Data from patients treated with PCI from the CONVERT trial were analyzed. RESULTS: Four 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. CONCLUSIONS: Patients receiving OD or BD thoracic radiotherapy have the same risk of developing BM. Larger tumors are associated with a higher risk of BM.
    Citation
    Levy A, Le Pechoux C, Mistry H, Martel-Lafay I, Bezjak A, Lerouge D, et al. Prophylactic cranial irradiation for limited-stage small-cell lung cancer patients: secondary findings from the prospective randomized phase 3 CONVERT trial. J Thorac Oncol. 2019 Feb;14(2):294-7.
    Journal
    Journal of Thoracic Oncology
    URI
    http://hdl.handle.net/10541/621548
    DOI
    10.1016/j.jtho.2018.09.019
    PubMed ID
    30292850
    Additional Links
    https://dx.doi.org/10.1016/j.jtho.2018.09.019
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jtho.2018.09.019
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