Prophylactic cranial irradiation in extensive small-cell lung cancer

Ben Slotman, Corinne Faivre-Finn, Gijs Kramer, Elaine Rankin, Michael Snee, Matthew Hatton, Pieter Postmus, Laurence Collette, Elena Musat, Suresh Senan

    Research output: Contribution to journalArticle

    636 Citations (Scopus)

    Abstract

    Background We conducted a randomized trial of prophylactic cranial irradiation in patients with extensive small-cell lung cancer who had had a response to chemotherapy. Methods Patients between the ages of 18 and 75 years with extensive small-cell lung cancer were randomly assigned to undergo prophylactic cranial irradiation (irradiation group) or receive no further therapy (control group). The primary end point was the time to symptomatic brain metastases. Computed tomography or magnetic resonance imaging of the brain was performed when any predefined key symptom suggestive of brain metastases was present. Results The two groups (each with 143 patients) were well balanced regarding baseline characteristics. Patients in the irradiation group had a lower risk of symptomatic brain metastases (hazard ratio, 0.27; 95% confidence interval [CI], 0.16 to 0.44; P<0.001). The cumulative risk of brain metastases within 1 year was 14.6% in the irradiation group (95% CI, 8.3 to 20.9) and 40.4% in the control group (95% CI, 32.1 to 48.6). Irradiation was associated with an increase in median disease-free survival from 12.0 weeks to 14.7 weeks and in median overall survival from 5.4 months to 6.7 months after randomization. The 1-year survival rate was 27.1% (95% CI, 19.4 to 35.5) in the irradiation group and 13.3% (95% CI, 8.1 to 19.9) in the control group. Irradiation had side effects but did not have a clinically significant effect on global health status. Conclusions Prophylactic cranial irradiation reduces the incidence of symptomatic brain metastases and prolongs disease-free and overall survival. (ClinicalTrials.gov number, NCT00016211.)
    Original languageEnglish
    Pages (from-to)664-672
    Number of pages9
    JournalNew England Journal of Medicine
    Volume357
    Issue number7
    Publication statusPublished - Aug 2007

    Fingerprint

    Cranial Irradiation
    Small Cell Lung Carcinoma
    Confidence Intervals
    Neoplasm Metastasis
    Brain
    Control Groups
    Disease-Free Survival
    Random Allocation
    Health Status
    Survival Rate
    Tomography
    Magnetic Resonance Imaging
    Drug Therapy
    Survival
    Incidence

    Cite this

    Slotman, B., Faivre-Finn, C., Kramer, G., Rankin, E., Snee, M., Hatton, M., ... Senan, S. (2007). Prophylactic cranial irradiation in extensive small-cell lung cancer. New England Journal of Medicine, 357(7), 664-672.
    Slotman, Ben ; Faivre-Finn, Corinne ; Kramer, Gijs ; Rankin, Elaine ; Snee, Michael ; Hatton, Matthew ; Postmus, Pieter ; Collette, Laurence ; Musat, Elena ; Senan, Suresh. / Prophylactic cranial irradiation in extensive small-cell lung cancer. In: New England Journal of Medicine. 2007 ; Vol. 357, No. 7. pp. 664-672.
    @article{580d53f92ff54583a854dd13c5fc84cf,
    title = "Prophylactic cranial irradiation in extensive small-cell lung cancer",
    abstract = "Background We conducted a randomized trial of prophylactic cranial irradiation in patients with extensive small-cell lung cancer who had had a response to chemotherapy. Methods Patients between the ages of 18 and 75 years with extensive small-cell lung cancer were randomly assigned to undergo prophylactic cranial irradiation (irradiation group) or receive no further therapy (control group). The primary end point was the time to symptomatic brain metastases. Computed tomography or magnetic resonance imaging of the brain was performed when any predefined key symptom suggestive of brain metastases was present. Results The two groups (each with 143 patients) were well balanced regarding baseline characteristics. Patients in the irradiation group had a lower risk of symptomatic brain metastases (hazard ratio, 0.27; 95{\%} confidence interval [CI], 0.16 to 0.44; P<0.001). The cumulative risk of brain metastases within 1 year was 14.6{\%} in the irradiation group (95{\%} CI, 8.3 to 20.9) and 40.4{\%} in the control group (95{\%} CI, 32.1 to 48.6). Irradiation was associated with an increase in median disease-free survival from 12.0 weeks to 14.7 weeks and in median overall survival from 5.4 months to 6.7 months after randomization. The 1-year survival rate was 27.1{\%} (95{\%} CI, 19.4 to 35.5) in the irradiation group and 13.3{\%} (95{\%} CI, 8.1 to 19.9) in the control group. Irradiation had side effects but did not have a clinically significant effect on global health status. Conclusions Prophylactic cranial irradiation reduces the incidence of symptomatic brain metastases and prolongs disease-free and overall survival. (ClinicalTrials.gov number, NCT00016211.)",
    author = "Ben Slotman and Corinne Faivre-Finn and Gijs Kramer and Elaine Rankin and Michael Snee and Matthew Hatton and Pieter Postmus and Laurence Collette and Elena Musat and Suresh Senan",
    note = "dc.publisher: Massachusetts Medical Society",
    year = "2007",
    month = "8",
    language = "English",
    volume = "357",
    pages = "664--672",
    journal = "New England Journal of Medicine",
    issn = "0028-4793",
    publisher = "Massachusetts Medical Society",
    number = "7",

    }

    Slotman, B, Faivre-Finn, C, Kramer, G, Rankin, E, Snee, M, Hatton, M, Postmus, P, Collette, L, Musat, E & Senan, S 2007, 'Prophylactic cranial irradiation in extensive small-cell lung cancer', New England Journal of Medicine, vol. 357, no. 7, pp. 664-672.

    Prophylactic cranial irradiation in extensive small-cell lung cancer. / Slotman, Ben; Faivre-Finn, Corinne; Kramer, Gijs; Rankin, Elaine; Snee, Michael; Hatton, Matthew; Postmus, Pieter; Collette, Laurence; Musat, Elena; Senan, Suresh.

    In: New England Journal of Medicine, Vol. 357, No. 7, 08.2007, p. 664-672.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Prophylactic cranial irradiation in extensive small-cell lung cancer

    AU - Slotman, Ben

    AU - Faivre-Finn, Corinne

    AU - Kramer, Gijs

    AU - Rankin, Elaine

    AU - Snee, Michael

    AU - Hatton, Matthew

    AU - Postmus, Pieter

    AU - Collette, Laurence

    AU - Musat, Elena

    AU - Senan, Suresh

    N1 - dc.publisher: Massachusetts Medical Society

    PY - 2007/8

    Y1 - 2007/8

    N2 - Background We conducted a randomized trial of prophylactic cranial irradiation in patients with extensive small-cell lung cancer who had had a response to chemotherapy. Methods Patients between the ages of 18 and 75 years with extensive small-cell lung cancer were randomly assigned to undergo prophylactic cranial irradiation (irradiation group) or receive no further therapy (control group). The primary end point was the time to symptomatic brain metastases. Computed tomography or magnetic resonance imaging of the brain was performed when any predefined key symptom suggestive of brain metastases was present. Results The two groups (each with 143 patients) were well balanced regarding baseline characteristics. Patients in the irradiation group had a lower risk of symptomatic brain metastases (hazard ratio, 0.27; 95% confidence interval [CI], 0.16 to 0.44; P<0.001). The cumulative risk of brain metastases within 1 year was 14.6% in the irradiation group (95% CI, 8.3 to 20.9) and 40.4% in the control group (95% CI, 32.1 to 48.6). Irradiation was associated with an increase in median disease-free survival from 12.0 weeks to 14.7 weeks and in median overall survival from 5.4 months to 6.7 months after randomization. The 1-year survival rate was 27.1% (95% CI, 19.4 to 35.5) in the irradiation group and 13.3% (95% CI, 8.1 to 19.9) in the control group. Irradiation had side effects but did not have a clinically significant effect on global health status. Conclusions Prophylactic cranial irradiation reduces the incidence of symptomatic brain metastases and prolongs disease-free and overall survival. (ClinicalTrials.gov number, NCT00016211.)

    AB - Background We conducted a randomized trial of prophylactic cranial irradiation in patients with extensive small-cell lung cancer who had had a response to chemotherapy. Methods Patients between the ages of 18 and 75 years with extensive small-cell lung cancer were randomly assigned to undergo prophylactic cranial irradiation (irradiation group) or receive no further therapy (control group). The primary end point was the time to symptomatic brain metastases. Computed tomography or magnetic resonance imaging of the brain was performed when any predefined key symptom suggestive of brain metastases was present. Results The two groups (each with 143 patients) were well balanced regarding baseline characteristics. Patients in the irradiation group had a lower risk of symptomatic brain metastases (hazard ratio, 0.27; 95% confidence interval [CI], 0.16 to 0.44; P<0.001). The cumulative risk of brain metastases within 1 year was 14.6% in the irradiation group (95% CI, 8.3 to 20.9) and 40.4% in the control group (95% CI, 32.1 to 48.6). Irradiation was associated with an increase in median disease-free survival from 12.0 weeks to 14.7 weeks and in median overall survival from 5.4 months to 6.7 months after randomization. The 1-year survival rate was 27.1% (95% CI, 19.4 to 35.5) in the irradiation group and 13.3% (95% CI, 8.1 to 19.9) in the control group. Irradiation had side effects but did not have a clinically significant effect on global health status. Conclusions Prophylactic cranial irradiation reduces the incidence of symptomatic brain metastases and prolongs disease-free and overall survival. (ClinicalTrials.gov number, NCT00016211.)

    M3 - Article

    VL - 357

    SP - 664

    EP - 672

    JO - New England Journal of Medicine

    JF - New England Journal of Medicine

    SN - 0028-4793

    IS - 7

    ER -

    Slotman B, Faivre-Finn C, Kramer G, Rankin E, Snee M, Hatton M et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. New England Journal of Medicine. 2007 Aug;357(7):664-672.