PMID- 25482023 OWN - NLM STAT- MEDLINE DCOM- 20151215 LR - 20181113 IS - 1879-4076 (Electronic) IS - 1879-4068 (Print) IS - 1879-4068 (Linking) VI - 6 IP - 2 DP - 2015 Mar TI - Prophylactic cranial irradiation in elderly patients with small cell lung cancer: findings from a North Central Cancer Treatment Group pooled analysis. PG - 119-26 LID - S1879-4068(14)00355-5 [pii] LID - 10.1016/j.jgo.2014.11.002 [doi] AB - OBJECTIVES: To examine the efficacy of prophylactic cranial irradiation (PCI) in elderly patients with small cell lung cancer (SCLC) (>/=70 years of age) from a pooled analysis of four prospective trials. MATERIALS & METHODS: One hundred fifty-five patients with SCLC (limited stage, LSCLC, and extensive stage, ESCLC) participated in four phase II or III trials. Ninety-one patients received PCI (30 Gy/15 or 25 Gy/10) and 64 patients did not receive PCI. Survival was compared in a landmark analysis that included only patients who had stable disease or better in response to primary therapy. RESULTS: Patients who received PCI had better survival than patients who did not receive PCI (median survival 12.0 months vs. 7.6 months, 3-year overall survival 13.2% vs. 3.1%, HR = 0.53 [95% CI 0.36-0.78], p = 0.001). On multivariate analysis of the entire cohort, the only factor that remained significant for survival was stage (ESCLC vs. LSCLC, p = 0.0072). In contrast, the multivariate analysis of patients who had ESCLC revealed that PCI was the sole factor associated with a survival advantage (HR = 0.47 [95% CI 0.24-0.93], p = 0.03). Grade 3 or higher adverse events (AEs) were significantly greater in patients who received PCI (71.4% vs. 47.5%, p = 0.0031), with non-neuro and non-heme being the specific AE categories most strongly correlated with PCI delivery. CONCLUSIONS: PCI was associated with a significant improvement in survival for our entire elderly SCLC patient cohort on univariate analysis. Multivariate analysis suggested that the survival advantage remained significant in patients with ESCLC. PCI was also associated with a modest increase in grade 3 or higher AEs. CI - Copyright (c) 2014 Elsevier Inc. All rights reserved. FAU - Rule, William G AU - Rule WG AD - Department of Radiation Oncology, Mayo Clinic Arizona, USA. Electronic address: rule.william@mayo.edu. FAU - Foster, Nathan R AU - Foster NR AD - Section of Biomedical Statistics and Informatics, Mayo Clinic Rochester, USA. FAU - Meyers, Jeffrey P AU - Meyers JP AD - Section of Biomedical Statistics and Informatics, Mayo Clinic Rochester, USA. FAU - Ashman, Jonathan B AU - Ashman JB AD - Department of Radiation Oncology, Mayo Clinic Arizona, USA. FAU - Vora, Sujay A AU - Vora SA AD - Department of Radiation Oncology, Mayo Clinic Arizona, USA. FAU - Kozelsky, Timothy F AU - Kozelsky TF AD - Department of Radiation Oncology, Mayo Clinic Rochester, USA. FAU - Garces, Yolanda I AU - Garces YI AD - Department of Radiation Oncology, Mayo Clinic Rochester, USA. FAU - Urbanic, James J AU - Urbanic JJ AD - Department of Radiation Oncology, Wake Forest School of Medicine, USA. FAU - Salama, Joseph K AU - Salama JK AD - Department of Radiation Oncology, Duke University School of Medicine, USA. FAU - Schild, Steven E AU - Schild SE AD - Department of Radiation Oncology, Mayo Clinic Arizona, USA. LA - eng GR - U10 CA035267/CA/NCI NIH HHS/United States GR - N01 CA035431/CA/NCI NIH HHS/United States GR - CA-37404/CA/NCI NIH HHS/United States GR - CA-35431/CA/NCI NIH HHS/United States GR - CA-35090/CA/NCI NIH HHS/United States GR - U10 CA037404/CA/NCI NIH HHS/United States GR - U10 CA180821/CA/NCI NIH HHS/United States GR - N01 CA035119/CA/NCI NIH HHS/United States GR - U10 CA063848/CA/NCI NIH HHS/United States GR - CA-35103/CA/NCI NIH HHS/United States GR - CA-25224/CA/NCI NIH HHS/United States GR - CA-35113/CA/NCI NIH HHS/United States GR - U10 CA035101/CA/NCI NIH HHS/United States GR - U10 CA035113/CA/NCI NIH HHS/United States GR - CA35119/CA/NCI NIH HHS/United States GR - CA-63848/CA/NCI NIH HHS/United States GR - U10 CA035415/CA/NCI NIH HHS/United States GR - U10 CA063849/CA/NCI NIH HHS/United States GR - U10 CA180882/CA/NCI NIH HHS/United States GR - CA-35415/CA/NCI NIH HHS/United States GR - U10 CA035431/CA/NCI NIH HHS/United States GR - U10 CA035119/CA/NCI NIH HHS/United States GR - CA-35101/CA/NCI NIH HHS/United States GR - U10 CA025224/CA/NCI NIH HHS/United States GR - U10 CA035090/CA/NCI NIH HHS/United States GR - CA-35267/CA/NCI NIH HHS/United States GR - CA-63849/CA/NCI NIH HHS/United States GR - U10 CA035103/CA/NCI NIH HHS/United States PT - Clinical Trial, Phase II PT - Clinical Trial, Phase III PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural DEP - 20141204 PL - Netherlands TA - J Geriatr Oncol JT - Journal of geriatric oncology JID - 101534770 SB - IM MH - Aged MH - Aged, 80 and over MH - Brain Neoplasms/mortality/*prevention & control/secondary MH - Cranial Irradiation/*methods MH - Female MH - Humans MH - Lung Neoplasms/mortality/*pathology MH - Male MH - Multivariate Analysis MH - Small Cell Lung Carcinoma/mortality/*prevention & control/secondary MH - Treatment Outcome PMC - PMC5722214 MID - NIHMS903163 OTO - NOTNLM OT - PCI OT - Prophylactic cranial irradiation OT - Small cell lung cancer COIS- Disclosures and Conflict of Interest Statements The authors have declared no conflicts of interest. EDAT- 2014/12/09 06:00 MHDA- 2015/12/17 06:00 PMCR- 2017/12/08 CRDT- 2014/12/09 06:00 PHST- 2014/07/17 00:00 [received] PHST- 2014/09/19 00:00 [revised] PHST- 2014/11/20 00:00 [accepted] PHST- 2014/12/09 06:00 [entrez] PHST- 2014/12/09 06:00 [pubmed] PHST- 2015/12/17 06:00 [medline] PHST- 2017/12/08 00:00 [pmc-release] AID - S1879-4068(14)00355-5 [pii] AID - 10.1016/j.jgo.2014.11.002 [doi] PST - ppublish SO - J Geriatr Oncol. 2015 Mar;6(2):119-26. doi: 10.1016/j.jgo.2014.11.002. Epub 2014 Dec 4.