Patterns of failure in limited-stage small cell lung cancer: Implications of TNM stage for prophylactic cranial irradiation

Publication date: Available online 1 August 2017
Source:Radiotherapy and Oncology
Author(s): Abraham J. Wu, Andrea Gillis, Amanda Foster, Kaitlin Woo, Zhigang Zhang, Daphna Y. Gelblum, Robert J. Downey, Kenneth E. Rosenzweig, Leonard Ong, Carmen A. Perez, M. Catherine Pietanza, Lee Krug, Charles M. Rudin, Andreas Rimner
Background and purposeThe relationship between tumor-node-metastasis (TNM) stage and patterns of failure in limited-stage small cell lung cancer (LS-SCLC) remains unclear. We hypothesized that TNM stage predicts brain metastasis risk, and could inform the use of prophylactic cranial irradiation.Material and methodsWe reviewed 283 patients with stage I–IIIB SCLC. Competing-risks regression was used to analyze local, distant, and brain failure. Multivariate analysis was used to evaluate the effect of treatment and clinical factors on failure and OS.ResultsPatients with stage I or II SCLC (35% of cohort) had significantly better survival and lower risk of distant and brain metastasis, compared with stage III patients. The 5-year cumulative incidence of brain metastasis for stage I/II and III were 12% and 26%, respectively. Stage had no correlation with local failure. On multivariate analysis, stage was independently prognostic for survival, distant metastasis risk, and brain metastasis risk.ConclusionsTNM staging predicts likelihood of distant metastasis, brain metastasis, and survival in LS-SCLC. This supports the routine use of TNM staging in clinical practice. The lower risk of brain metastasis in stage I and II SCLC suggests that prophylactic cranial irradiation could play a more limited role in treatment of early-stage disease.



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