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G. Cook
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P1.07 - Poster Session/ Small Cell Lung Cancer (ID 221)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.07-007 - Prophylactic Cranial Irradiation in Extensive Stage Small Cell Lung Cancer: The Ottawa Hospital Experience (ID 1446)
09:30 - 17:00 | Author(s): G. Cook
- Abstract
Background:
The role of radiation has been investigated in extensive stage small cell lung cancer (ES-SCLC) in two-fold: prophylactic cranial irradiation (PCI) and consolidative radiotherapy. A randomized control trial was published in 2007 (Slotman) which showed benefits for PCI in median survival and decreased cumulative risk of symptomatic brain metastases. We conducted a retrospective study to evaluate the uptake of PCI at The Ottawa Hospital (TOH) for ES-SCLC and its impact on time to brain metastasis and survival. TOH is the sole provider of cancer services for a population of 1.3 million.
Methods:
The medical records of 605 patients (206 limited stage, 399 extensive stage) with small cell lung cancer between Jan. 1, 2005 and Dec. 31, 2011 were reviewed. The cumulative incidence of brain metastases and cumulative proportion surviving was estimated using the Kaplan–Meier method comparing patients receiving PCI or not. Differences between the groups with covariates including age, gender, smoking status, ECOG score, extrathoracic involvement, and response to chemotherapy were analyzed using t-test.
Results:
158 out of 399 ES-SCLC patients (39.6%) had no brain metastases at diagnosis, received chemotherapy, and had a partial or complete response. Of the 158 patients with these criteria, 69 patients received PCI and 89 did not. 90 patients had brain metastasis on diagnosis, and 151 patients were not eligible or had no response/progression to chemotherapy. On multivariate analysis, the only statistically significant predictors of overall survival were initial performance status and use of PCI. Using t-test, only partial vs. complete response to chemotherapy was found to be significantly different between the PCI and no PCI groups. There was a statistically significant difference in survival (p= 0.0021) and time to brain metastasis curves (p = 0.00029). Median survival for PCI and non-PCI groups was 14.0 and 8.2 months respectively. Median time to brain metastasis was 18.0 and 9.0 months respectively. There was no significant difference in incidence of brain metastases (40.6% vs. 43.8%) in either group. With regards to uptake of PCI for ES-SCLC at The Ottawa Hospital, 24.2% (16/66) of patients before Jan. 1, 2008 were treated with PCI compared to 57.6% (53/92) after 2008. Figure 1
Conclusion:
PCI in the setting of at least partial response to chemotherapy was found to have a survival benefit and prolongation of time to brain metastasis. This has corresponded with an increased uptake of PCI at The Ottawa Hospital since publication of the EORTC 22993-08993 in 2007.
