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S. Chattopadhyay



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    MO13 - SCLC I (ID 118)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Medical Oncology
    • Presentations: 1
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      MO13.06 - Prophylactic Cranial Irradiation for patients with Small Cell Lung Cancer with 30 Gy in 10 fractions - analysis of efficacy and subset analysis of neurocognitive impairment. (ID 1310)

      10:30 - 12:00  |  Author(s): S. Chattopadhyay

      • Abstract
      • Presentation
      • Slides

      Background
      Prophylactic cranial irradiation (PCI) plays crucial role to prevent brain metastasis for small cell lung cancer (SCLC) patients – both limited stage (LS) or extensive (ES) – who respond to initial therapy. For better quality-adjusted life expectancy and to avoid neurointellectual impairment (NIP), optimum dose and fractionation for PCI needs to be explored, with due consideration to coexisting medical comorbidities that might enhance the adverse events, specially neurocognitive functions. Aim of the study was to find the safety and efficacy of PCI with the dose of 30 Gy/ 10 fractions and to analyze its impact on NIP with special focus on any possible influence of these medical comorbidities.

      Methods
      This is an on-going single arm multicentric trial initiated in November 2010 where both LS- as well as ES-SCLC patients who responded to initial therapy and were not having any visceral metastasis are offered PCI for a dose of 30 Gy in 10 fractions with CT-based planning. All patients received Platinum + Etoposide for 6 cycles. LS-SCLC patients received, in addition, concomitant thoracic radiation after 2 cycles of chemotherapy. To minimize neuro-psychological impairment, at least 2 weeks gap is given before PCI and after completion of all chemotherapy to avoid entry of more chemotherapeutic agent into brain parenchyma by way of radiation induced permeability alterations. All relevant medical comorbidities (Diabetes, Hyperlipidimia, previous history of CVA) are recorded. Neuropsychological screening measure of immediate and delayed verbal memory by using Hopkins Verbal Learning Test - Revised (HVLT - R), assessment of cognitive function using Mini-Mental Status Examination (MMSE) and Instrumental Activities of Daily Living (IADL) questionnaires are applied before initiation of PCI and on follow up .

      Results
      Result of first 38 patients receiving PCI (LS- SCLC = 28, ES-SCLC = 10) with minimum duration of follow up of 18 months is being presented. Brain metastasis, in spite of PCI was faced by 0/28 of LS and 1/10 of ES-SCLC. Median duration of survival was 8.5 months for ES and 14 months for LS-SCLC. 1/10 ES-SCLC and 16/28 LS-SCLC lived one year. Corresponding data for 18 months is 0/10 and 4/28 respectively. MMSE deterioration was noted in 12/38 patients. Subset analysis of these 12 patients revealed 8/12 are having long standing diabetes and another 2/12 had both diabetes and hyperlipidimia. HVLT decline in immediate recall (13/38) was in 10/12 patients having MMSE deterioration and 9 out of these 12 had delayed recall deterioration also. So NIP (as evidenced by HVLT) was found in 10/14 diabetic patients receiving PCI, contrary to 3/24 non-diabetics (P = 0.0004).

      Conclusion
      30Gy/ 10 fractions is an effective PCI protocol for both LS and ES – SCLC. But patients with medical comorbidities, specially long standing Diabetes (and may be hyperlipidaemia) are more prone to develop impairment of neurocognitive functions (possibly due to presence of cerebral microinfarcts and lacunar infarcts) and deserve special attention and should be treated possibly with lower dose / fraction size less than 3 Gy. Further study with more patient accrual is required to arrive at a definite conclusion.

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