Association of Twice-Daily Radiotherapy With Subsequent Brain Metastases in Adults With Small Cell Lung Cancer

Autor: Kaixian Zhang, Shuanghu Yuan, Hui Li, Feng-Ming Spring Kong, Chuqing Wei, Hui Zhu, Peng Zeng, Jinbo Yue, Xudong Hu, Haiyan Zeng, Chuanwang Miao, Meng Ni, Huiming Yu, Heming Lu, Chen Hu, Bingjie Fan, Jinming Yu, Jingyi Shen, Miaomiao Hu, Dan Xiao, Hong Ge, Guoqin Qiu, Rui Li
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: JAMA Network Open
ISSN: 2574-3805
Popis: Importance Although thoracic twice-daily radiotherapy (TDRT) is one of the standards of care for small cell lung cancer, its association with brain metastases remains unknown. Objective To investigate the association of TDRT vs once-daily radiotherapy (ODRT) with brain metastases after prophylactic cranial irradiation in patients with small cell lung cancer. Design, Setting, and Participants In this multicenter cohort study, data on 778 consecutive patients with small cell lung cancer who had undergone thoracic radiotherapy (609 received ODRT and 169 received TDRT), chemotherapy, and prophylactic cranial irradiation were retrieved from the databases of 8 hospitals in China between July 1, 2003, and June 30, 2016. A 1:1 propensity score matching approach was used to control for confounding between the ODRT and TDRT groups. Confounding covariates included 8 demographic variables and 8 treatment-related covariates. Data analysis was conducted from November 1, 2017, to May 31, 2018, and reanalyzed for revision. Exposures The ODRT group received 50 to 66 Gy given in 25 to 33 fractions. The TDRT group received 45 Gy given in 30 fractions. Main Outcomes and Measures The primary end point was brain metastases. Secondary end points included progression-free survival and overall survival. Results Of the 778 patients (median age, 55 years [interquartile range, 48-61 years]), 204 were women and 574 were men. At a median follow-up of 23.6 months (interquartile range, 14.2-38.2 months), 131 patients (16.8%) experienced brain metastases. The rate of brain metastasis at 3 years in the TDRT group was significantly higher than in the ODRT group (26.0% vs 16.9%; hazard ratio, 1.55; 95% CI, 1.06-2.26; P = .03). Of the 338 matched patients (169 in the ODRT group vs 169 in the TDRT group), 60 (17.8%) experienced brain metastases, with a rate at 3 years of 14.9% in the ODRT group vs 26.0% in the TDRT group (hazard ratio, 1.71; 95% CI, 1.02-2.88; P = .04). Progression-free survival was similar in both the whole cohort and the matched cohort. Median overall survival in the ODRT group tended to be significantly longer than in the TDRT group after matching (47.2 vs 32.8 months; hazard ratio, 1.41; 95% CI, 0.99-2.01; P = .06). Conclusions and Relevance In this study, patients with small cell lung cancer who received thoracic TDRT appeared to have a higher risk of brain metastases than those who received ODRT, which supports the need for further prospective randomized clinical trials, especially in China and other parts of Asia.
This multicenter cohort study investigates the association of thoracic twice-daily radiotherapy vs once-daily radiotherapy with brain metastases after prophylactic cranial irradiation in adult Chinese patients with small cell lung cancer (SCLC).
Key Points Question Does thoracic twice-daily radiotherapy increase the risk for brain metastases after prophylactic cranial irradiation in patients with small cell lung cancer? Findings This multicenter cohort study, involving 778 patients during the period from 2003 to 2016, revealed a significantly higher rate of brain metastasis among patients who underwent twice-daily radiotherapy than among those who underwent once-daily radiotherapy, which was further confirmed in subsequent propensity score analysis of 338 patients. Meaning Compared with patients with small cell lung cancer who received once-daily radiotherapy, those who received twice-daily radiotherapy were more likely to experience brain metastases after prophylactic cranial irradiation.
Databáze: OpenAIRE
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