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The abstract, “Phase III Comparison of Prophylactic Cranial Irradiation Versus Observation in Patients with Locally Advanced Non-small-cell Lung Cancer: Updated Analysis of RTOG 0214,” was presented during the Plenary Session at 12:30 p.m., Central time on September 7, 2012.
Phase III Comparison of Prophylactic Cranial Irradiation Versus Observation in Patients with Locally Advanced Non-small-cell Lung Cancer: Updated Analysis of RTOG 0214
E. M. Gore1, R. Paulus2, S. Wong1, A. Sun3, G. Videtic4, S. Dutta5, M. Suntharalingam6, Y. Chen7, L. E. Gaspar8, H. Choy9, 1Medical College of Wisconsin, Milwaukee, 2Radiation Therapy Oncology Group, Philadelphia, 3Princess Margaret Hospital-University Health Network, Toronto, Ontario, Canada, 4Cleveland Clinic Foundation, Cleveland, 5Michigan Cancer Research Consortium, Ann Arbor, Mich., 6University of Maryland, Baltimore, 7University of Rochester, Rochester, N.Y., 8University of Colorado, Aurora, Colo., 9UT Southwestern, Dallas.
Purpose/Objective(s): To determine if prophylactic cranial irradiation (PCI) improves survival in locally advanced non-small-cell lung cancer (LA-NSCLC). This is an updated 5-year analysis.
Materials/Methods: Patients with stage III NSCLC without disease progression after treatment with surgery and/or radiation therapy (RT) with or without chemotherapy were eligible. Participants were stratified by stage (IIIA v IIIB), histology (nonsquamous v squamous), and therapy (surgery v none) and were randomly assigned to PCI or observation. PCI was delivered to 30 Gy in 15 fractions. The primary end point of the study was overall survival (OS). Secondary end points were disease-free survival (DFS), neurocognitive function (NCF), and quality of life. Kaplan-Meier and log-rank analyses were used for OS and DFS. The incidence of brain metastasis (BM) was evaluated with the logistic regression model.
Results: A total 356 patients were enrolled with 340 eligible for analysis. The median follow-up time was 24.2 months for all patients and 58.6 months for living patients. The 5-year OS (P = .57; 26.1% v 24.6% for PCI v observation) and 5-year DFS (P = .13; 18.5% v 14.9% for PCI v observation) were not significantly different. The 5-year rates of BM were significantly different (P = .009; 17.3% v 26.8% for PCI v observation). Of the patients who failed, 10% of patients on the PCI arm and 23% of patients on the observation arm experienced failure in the brain initially. Brain metastases were the only component of first failure in 9.1% and 21.5% of patients with and without PCI.. On multivariate analysis PCI is significantly associated with decreased BM. Non-squamous histology was associated with increased risk of BM. The overall rate of BM in this trial was insufficient for reliable subset analyses by histology.
Conclusions: In patients with stage III disease without progression of disease after therapy, PCI decreased the 5- year rate of BM but did not improve OS or DFS. This study confirms the effectiveness of PCI for prevention of brain failures. Further information is needed to determine which patient subset could derive a survival benefit from PCI.
Author Disclosure Block: E.M. Gore: None. R. Paulus: None. S. Wong: None. A. Sun: None. G. Videtic: None. S. Dutta: None. M. Suntharalingam: None. Y. Chen: None. L.E. Gaspar: None. H. Choy: None.
American Society for Radiation Oncology
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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American Society for Radiation Oncology. "Brain Radiation After Lung Cancer Treatment Reduces Risk Of Cancer Spreading." Medical News Today. MediLexicon, Intl., 10 Sep. 2012. Web.
23 Apr. 2014. <http://www.medicalnewstoday.com/releases/249988>
American Society for Radiation Oncology. (2012, September 10). "Brain Radiation After Lung Cancer Treatment Reduces Risk Of Cancer Spreading." Medical News Today. Retrieved from
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