Patterns of brain metastasis immediately before prophylactic cranial irradiation (PCI): implications for PCI optimizatio
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RESEARCH
Open Access
Patterns of brain metastasis immediately before prophylactic cranial irradiation (PCI): implications for PCI optimization in limitedstage small cell lung cancer Xiao Chu1,2†, Shuyan Li1,2†, Bingqing Xia2,3, Li Chu1,2, Xi Yang1,2, Jianjiao Ni1,2, Liqing Zou1,2, Yida Li1,2, Congying Xie4, Jie Lin5* and Zhengfei Zhu1,2*
Abstract Background: Prophylactic cranial irradiation (PCI) is indicated for limited-stage small cell lung cancer (LS-SCLC) with good response to chemoradiotherapy (CRT). However, brain metastasis (BM) developed in LS-SCLC before PCI is not rare. In this study, we comprehensively investigated the features of pre-PCI BMs, aiming to explore the potential of PCI optimization for LS-SCLC. Methods: One-hundred-ten LS-SCLC patients achieving clinical complete remission after definitive CRT with contrastenhanced cranial magnetic resonance imaging (MRI) at baseline and immediately before PCI were included. The time trend and risk factors for pre-PCI BM were evaluated. Several radiological features, including numbers, sizes, and locations of pre-PCI BMs, were investigated to explore the technical feasibility of stereotactic radiotherapy and hippocampal-avoidance (HA) PCI. Results: Twenty-four (21.8%) of the LS-SCLC patients harbored pre-PCI BM, all except one were asymptomatic. CRT duration (CRT-D) was the only independent risk factor for pre-PCI BM. The pre-PCI BM rate gradually increased in line with a growing time interval between treatment initiation and pre-PCI MRI. Pre-PCI BM and prolonged CRT-D were both correlated with worse overall survival. Of 129 pre-PCI intracranial lesions, 2 (1.5%) were in the HA region. Eight of the 24 (33.3%) pre-PCI BM patients were ineligible for stereotactic radiotherapy. Conclusion: Our findings suggest that PCI is still of importance in LS-SCLC, and MRI evaluation before PCI is indispensable. Investigations are warranted to explore the possibility of moving PCI up to before CRT completion in LS-SCLC patients with prolonged CRT-D. HA-PCI could be considered to reduce neurotoxicity. Keywords: Limited-stage small cell lung cancer, Prophylactic cranial irradiation, Chemoradiotherapy duration, Brain metastasis
* Correspondence: [email protected]; [email protected] † Xiao Chu and Shuyan Li contributed equally to this work. 5 Department of Medical Oncology, the Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming 650101, Yunnan, China 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, XuHui District, Shanghai 200032, China Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
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