The following is a summary of “Impact of Prophylactic Cranial Irradiation and Consolidative Thoracic Radiation Therapy for Extensive Stage Small-Cell Lung Cancer in the Transition to the Chemo-Immunotherapy Era: A Single Institution Series,” published in the December 2023 issue of Pulmonology by Gross, et al.
Extensive-stage small-cell lung cancer (ES-SCLC) still has a low survival rate because it spreads quickly, even though survival rates have gone up since immunotherapy was added to normal treatment. Because of the high rate of return, there is disagreement about the role of consolidative thoracic radiation treatment (TRT) and preventive cranial irradiation (PCI) in ES-SCLC. The researchers reported the results of their institution’s study on how PCI and TRT help people with ES-SCLC.163 people with ES-SCLC who did not have intracranial metastases at the time of diagnosis were included.
Standard of care said that all patients had to finish systemic treatment, which could have been done with or without immunotherapy. The groups were split into groups based on whether they used systemic therapy or PCI and TRT treatment. Kaplan-Meier method was used to measure overall survival (OS) and progression-free survival (PFS), and the log-rank test was used to compare them. Multivariable (MVA) Cox regression was used to figure out the effects of TRT and PCI. About 74 patients (45.4%) got TRT, and 54 patients (33.1%) got PCI.
The range of follow-ups was from 17 to 85 months. The median OS went up from 10 months to 15 months after PCI (P =.02), and the median PFS went up from 5 months to 8.5 months (P =.02). These changes were still significant on MVA (P =.02 for OS and P =.02 for PFS). OS improved with TRT in UVA (P = 0.002) but not MVA. TRT did not make PFS better. This study used both chemotherapy and chemo-immunotherapy and found that patients with ES-SCLC had better results when PCI was added. On the other hand, TRT did not improve either OS or PFS. To find out what role TRT and PCI play in the age of chemo-immunotherapy, a new study was needed.
Source: sciencedirect.com/science/article/abs/pii/S1525730423001547
