| Title | Association of Twice-Daily Radiotherapy With Subsequent Brain Metastases in Adults With Small Cell Lung Cancer |
| Authors | Zeng, Haiyan Li, Rui Hu, Chen Qiu, Guoqin Ge, Hong Yu, Huiming Zhang, Kaixian Hu, Miaomiao Zeng, Peng Xiao, Dan Miao, Chuanwang Wei, Chuqing Ni, Meng Shen, Jingyi Li, Hui Yue, Jinbo Lu, Heming Fan, Bingjie Zhu, Hui Hu, Xudong Kong, Feng-Ming (Spring) Yu, Jinming Yuan, Shuanghu |
| Affiliation | Shandong Univ, Shandong Canc Hosp, Dept Radiat Oncol, 440 Jiyan Rd, Jinan 250117, Shandong, Peoples R China Shandong Acad Med Sci, Jinan, Shandong, Peoples R China Univ Elect Sci & Technol China, Sch Med, Sichuan Canc Hosp & Inst, Dept Radiat Oncol,Sichuan Canc Ctr, Chengdu, Sichuan, Peoples R China Johns Hopkins Univ, Sch Med, Sidney Kimmel Comprehens Canc Ctr, Baltimore, MD USA Zhejiang Canc Hosp, Dept Radiat Oncol, Hangzhou, Zhejiang, Peoples R China Zhengzhou Univ, Henan Canc Hosp, Affiliated Canc Hosp, Dept Radiat Oncol, Zhengzhou, Henan, Peoples R China Peking Univ, Canc Hosp & Inst, Key Lab Carcinogenesis & Translat Res, Minist Educ,Dept Radiat Oncol, Beijing, Peoples R China Tengzhou Cent Peoples Hosp, Dept Oncol, Tengzhou, Shandong, Peoples R China Nanchang Univ, Affiliated Hosp 2, Dept Emergency, Nanchang, Jiangxi, Peoples R China Jiangxi Canc Hosp, Dept Oncol, Nanchang, Jiangxi, Peoples R China Jinan Univ, Shandong Acad Med Sci, Sch Med & Life Sci, Jinan, Shandong, Peoples R China Shandong Univ, Jinan, Shandong, Peoples R China Henan Univ, Affiliated Hosp 1, Dept Oncol, Kaifeng, Henan, Peoples R China Peoples Hosp Guangxi Zhuang Autonomous Reg, Dept Radiat Oncol, Nanning, Guangxi, Peoples R China Case Western Reserve Univ, Dept Radiat Oncol, Cleveland, OH 44106 USA |
| Issue Date | 2019 |
| Publisher | JAMA NETWORK OPEN |
| Abstract | 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. |
| URI | http://hdl.handle.net/20.500.11897/543633 |
| ISSN | 2574-3805 |
| DOI | 10.1001/jamanetworkopen.2019.0103 |
| Indexed | ESCI |
| Appears in Collections: | 北京肿瘤医院 |
