Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation. Issue 1 (October 2017)

• Record Type: Journal Article
• Authors: Wu, Abraham J.; Gillis, Andrea; Foster, Amanda; Woo, Kaitlin; Zhang, Zhigang; Gelblum, Daphna Y.; Downey, Robert J.; Rosenzweig, Kenneth E.; Ong, Leonard; Perez, Carmen A.; Pietanza, M. Catherine; Krug, Lee; Rudin, Charles M.; Rimner, Andreas
• Is Part Of: Radiotherapy and oncology. Volume 125:Issue 1(2017:Oct.)
• Page Start: 130
• Page End: 135
• Publication Date: 2017-10
• Subjects: Small cell lung cancer -- Radiotherapy -- Prophylactic cranial irradiation -- Staging; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2017.07.019
• Languages: English
• ISSNs: 0167-8140

Abstract

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.