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Ana Gonzalez-Ling
Author of
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P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.01-03 - Effect of Prophylactic Cranial Irradiation on Cognitive Function and QoL in NSCLC Patients at High Risk of Brain Metastases (ID 14166)
16:45 - 18:00 | Author(s): Ana Gonzalez-Ling
- Abstract
Background
Up to 50% of NSCLC patients develop brain metastases (BM). Prophylactic Cranial Irradiation (PCI) is a potentially useful strategy to prevent this event, although its use remains controversial due to inherent risks. Therefore, actions such as dose adjustment for Whole Brain Radiotherapy (WBRT), or hippocampal-sparing techniques have been explored. We evaluated the impact of PCI on cognitive function and Quality of Life (QoL).
a9ded1e5ce5d75814730bb4caaf49419 Method
Within the clinical trial NCT01603849 we evaluated a total of 84 histologically-confirmed NSCLC patients with high risk of developing BM (adenocarcinomas harboring oncodrivers (EGFR or ALK) and/or carcinoembryonic antigen (CAE) level at diagnosis ≥20 pg/mL). Patients were randomized 1:1, 41 to receive PCI and 43 to observation. Cognitive function (CF) was evaluated before and after treatment and at 6, 9 and 12 months with Mini Mental State Examination (MMSE). Reliable Change Index was used to evaluate the effect on CF. QoL was assessed through the European Organization for Research and Treatment of Cancer (EORTC-QLQ-30). Differences between groups were compared with Mann Whitney U and Friedman test. OS was estimated from the first MRI assessing the absence of BM until death/last follow-up with Kaplan-Meier and compared with Log-Rank test.
4c3880bb027f159e801041b1021e88e8 Result
83.3% of patients presented an EGFR-mutation (n=60) or ALK-rearrangement (n=6). Median OS was 42.8 vs. 25.9 months among patients with or without PCI (p=0.031). MMSE scores and median score values for global QoL, fatigue and cognitive functioning did not differ among groups or at baseline and follow-up. There were also no differences in percentual change at 1-yr (Table).
8eea62084ca7e541d918e823422bd82e ConclusionClinical changes (MMSE)
3 months
6 months
9 months
1 yr
n/N (%)
n/N (%)
n/N (%)
n/N (%)
Without PCI
Without Changes
38/43 (88.4)
34/42 (81)
34/42 (81.0)
29/37 (78.4)
Cognitive Deterioration
0/43 (0)
2/42 (4.8)
0/42 (0)
0/37(0)
Cognitive Improvement
5/43 (11.6)
6/42 (14.2)
8/42 (19.0)
8/37 (21.6)
With PCI
Without Changes
39/41 (95.1)
31/34 (91.2)
31/34 (91.2)
27/31(87.1)
Cognitive Deterioration
1/41 (2.4)
0/34 (0)
0/34 (0)
1/31(3.2)
Cognitive Improvement
1/41 (2.4)
3/34 (8.8)
3/34 (8.8)
3/31 (9.7)
Baseline
3 months
6 months
9 months
1 yr
p-Value (*)
Diff. at 1 yr
Median (IQR)
Median (IQR)
Median (IQR)
Median (IQR)
Median (IQR)
Median (IQR)
Global QoL
Without PCI
66.7 (50.0 - 83.3)
66.7 (50.0 - 83.3)
66.7 (64.6 - 83.3)
83.3 (66.7 - 85.4)
83.3 (75.0 - 87.5)
<0.001
8.3 (0.0 - 29-2)
With PCI
66.7 (50.0 - 83.3)
66.7 (50.0 - 83.3)
66.6 (66.7 - 83.3)
83.3 (66.7 - 83.3)
83.3 (75.0 - 83.3)
<0.001
0.0 (0 - 25.0)
p-Value (diff between groups)
0.956
0.786
0.903
0.172
0.595
0.791
Fatigue
Without PCI
22.2 (11.1 - 44.4)
33.3 (22.2 - 44.4)
22.2 (11.1 - 44.4)
22.2 (11.1 - 44.4)
22.2 (11.1 - 33.3)
<0.001
0.0 (-22.2 - 0.0)
With PCI
22.2 (5.6 -33.3)
33.3 (11.1 - 33.3)
22.2 (8.3 - 33.3)
22.2 (8.3 - 33.3)
22.2 (0.0 - 33.3)
<0.001
0 (0 - 0)
p-Value (diff between groups)
0.493
0.132
0.942
0.931
0.93
0.553
Cognitive
Without PCI
83.3 (66.7 - 100.0)
83.3 (66.7 - 100.0)
83.3 (66.7 - 100.0)
73.3 (83.3 - 100.0)
73.3 (83.3 - 100.0)
0.004
0 (0 - 0)
With PCI
83.3 (66.7 - 100.0)
83.3 (66.7 - 100.0)
83.3 (66.7 - 100.0)
91.7 (70.8 - 100.0)
83.3 (83.3 - 100.0)
0.017
0.0 (0.0 - 0.0)
p-Value (diff between groups)
0.854
0.983
0.521
0.411
0.757
0.734
PCI was not associated with significant differences in MMSE and QoL scores, furthermore there were no differences when assessing specific subscales (e.g. fatigue and cognitive functioning). These results along with the clinical benefit in OS highlight the benefit of this approach particularly among patients at high risk of developing BM.
6f8b794f3246b0c1e1780bb4d4d5dc53
