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Prophylactic cranial irradiation in elderly patients with small cell lung cancer: findings from a North Central Cancer Treatment Group pooled analysis.

Publication ,  Journal Article
Rule, WG; Foster, NR; Meyers, JP; Ashman, JB; Vora, SA; Kozelsky, TF; Garces, YI; Urbanic, JJ; Salama, JK; Schild, SE
Published in: J Geriatr Oncol
March 2015

OBJECTIVES: To examine the efficacy of prophylactic cranial irradiation (PCI) in elderly patients with small cell lung cancer (SCLC) (≥70 years of age) from a pooled analysis of four prospective trials. MATERIALS & METHODS: One hundred fifty-five patients with SCLC (limited stage, LSCLC, and extensive stage, ESCLC) participated in four phase II or III trials. Ninety-one patients received PCI (30 Gy/15 or 25 Gy/10) and 64 patients did not receive PCI. Survival was compared in a landmark analysis that included only patients who had stable disease or better in response to primary therapy. RESULTS: Patients who received PCI had better survival than patients who did not receive PCI (median survival 12.0 months vs. 7.6 months, 3-year overall survival 13.2% vs. 3.1%, HR = 0.53 [95% CI 0.36-0.78], p = 0.001). On multivariate analysis of the entire cohort, the only factor that remained significant for survival was stage (ESCLC vs. LSCLC, p = 0.0072). In contrast, the multivariate analysis of patients who had ESCLC revealed that PCI was the sole factor associated with a survival advantage (HR = 0.47 [95% CI 0.24-0.93], p = 0.03). Grade 3 or higher adverse events (AEs) were significantly greater in patients who received PCI (71.4% vs. 47.5%, p = 0.0031), with non-neuro and non-heme being the specific AE categories most strongly correlated with PCI delivery. CONCLUSIONS: PCI was associated with a significant improvement in survival for our entire elderly SCLC patient cohort on univariate analysis. Multivariate analysis suggested that the survival advantage remained significant in patients with ESCLC. PCI was also associated with a modest increase in grade 3 or higher AEs.

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Published In

J Geriatr Oncol

DOI

EISSN

1879-4076

Publication Date

March 2015

Volume

6

Issue

2

Start / End Page

119 / 126

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Small Cell Lung Carcinoma
  • Multivariate Analysis
  • Male
  • Lung Neoplasms
  • Humans
  • Female
  • Cranial Irradiation
  • Brain Neoplasms
  • Aged, 80 and over
 

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Rule, W. G., Foster, N. R., Meyers, J. P., Ashman, J. B., Vora, S. A., Kozelsky, T. F., … Schild, S. E. (2015). Prophylactic cranial irradiation in elderly patients with small cell lung cancer: findings from a North Central Cancer Treatment Group pooled analysis. J Geriatr Oncol, 6(2), 119–126. https://doi.org/10.1016/j.jgo.2014.11.002
Rule, William G., Nathan R. Foster, Jeffrey P. Meyers, Jonathan B. Ashman, Sujay A. Vora, Timothy F. Kozelsky, Yolanda I. Garces, James J. Urbanic, Joseph K. Salama, and Steven E. Schild. “Prophylactic cranial irradiation in elderly patients with small cell lung cancer: findings from a North Central Cancer Treatment Group pooled analysis.J Geriatr Oncol 6, no. 2 (March 2015): 119–26. https://doi.org/10.1016/j.jgo.2014.11.002.
Rule WG, Foster NR, Meyers JP, Ashman JB, Vora SA, Kozelsky TF, et al. Prophylactic cranial irradiation in elderly patients with small cell lung cancer: findings from a North Central Cancer Treatment Group pooled analysis. J Geriatr Oncol. 2015 Mar;6(2):119–26.
Rule, William G., et al. “Prophylactic cranial irradiation in elderly patients with small cell lung cancer: findings from a North Central Cancer Treatment Group pooled analysis.J Geriatr Oncol, vol. 6, no. 2, Mar. 2015, pp. 119–26. Pubmed, doi:10.1016/j.jgo.2014.11.002.
Rule WG, Foster NR, Meyers JP, Ashman JB, Vora SA, Kozelsky TF, Garces YI, Urbanic JJ, Salama JK, Schild SE. Prophylactic cranial irradiation in elderly patients with small cell lung cancer: findings from a North Central Cancer Treatment Group pooled analysis. J Geriatr Oncol. 2015 Mar;6(2):119–126.
Journal cover image

Published In

J Geriatr Oncol

DOI

EISSN

1879-4076

Publication Date

March 2015

Volume

6

Issue

2

Start / End Page

119 / 126

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Small Cell Lung Carcinoma
  • Multivariate Analysis
  • Male
  • Lung Neoplasms
  • Humans
  • Female
  • Cranial Irradiation
  • Brain Neoplasms
  • Aged, 80 and over