title: Circulating tumor cells correlate with recurrence in stage III small-cell lung cancer after systemic chemoradiotherapy and prophylactic cranial irradiation.
abstract: OBJECTIVE
  We investigated the correlation between circulating tumor cells and the incidence of brain metastases as a first site of recurrence among patients with small-cell lung cancer after systemic chemoradiotherapy and prophylactic cranial irradiation. In addition, we assessed the contribution of circulating tumor cells for planning the appropriate total dose of prophylactic cranial irradiation for small-cell lung cancer.
  
  
  METHODS
  Patients (n = 112) with diagnosed Stage III small-cell lung cancer were treated with four cycles of platinum-based regimen and concurrent chest irradiation, and then prophylactic cranial irradiation. Blood samples for circulating tumor cell analysis were obtained before the initiation of chemotherapy and after the first and fourth cycle of chemotherapy.
  
  
  RESULTS
  Circulating tumor cells after the first cycle of chemotherapy correlated with tumor response after completion of chemotherapy (P = 0.012). Patients with brain as the ﬁrst site suffered a higher rate of further metastases to other organs, and local recurrence, compared with those whose first site was the other organs (P < 0.001), and their survival rates were worse. Circulating tumor cells at baseline were the sole independent prognostic factor for specific progression-free survival. Receiver operating characteristic curves based on median specific progression-free survival revealed a circulating tumor cell cutoff at baseline of 218, and circulating tumor cells ≤218 at baseline correlated with significantly higher progression-free survival (P = 0.007), specific progression-free survival (P = 0.001) and overall survival (P = 0.001).
  
  
  CONCLUSIONS
  Circulating tumor cells prior to the initiation of chemotherapy are a valuable predictor of specific progression-free survival in Stage III small-cell lung cancer. For patients with circulating tumor cells >218, prophylactic cranial irradiation at a total dose of 30 Gy in 15 fractions is insufficient.
authors.affiliation: Shandong University, Shandong Cancer Hospital, Jinan.
authors.forename: Lei
authors.initials: L
authors.lastname: Fu
authors.affiliation: Shandong Medical College, Jinan.
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Surgery, Shandong Cancer Hospital, Shandong University, Jinan.
authors.forename: Hui
authors.initials: H
authors.lastname: Fu
authors.affiliation: Department of Surgery, Shandong Cancer Hospital, Shandong University, Jinan.
authors.forename: Liqing
authors.initials: L
authors.lastname: Liu
authors.affiliation: Shandong University, Shandong Cancer Hospital, Jinan.
authors.forename: Shuanghu
authors.initials: S
authors.lastname: Yuan
authors.affiliation: Department of Pathology, Shandong Cancer Hospital, Shandong University, Jinan.
authors.forename: Yongsheng
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Nuclear Medicine, Shandong Cancer Hospital, Shandong University, Jinan, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Fu
authors.affiliation: Shandong University, Shandong Cancer Hospital, Jinan fulexray@gmail.com.
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
mesh_terms: D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D001932:Brain Neoplasms / Q000453:epidemiology / Q000517:prevention & control* / Q000556:secondary; D018288:Carcinoma, Small Cell / Q000453:epidemiology / Q000517:prevention & control / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D002681:China / Q000453:epidemiology; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D016896:Treatment Outcome
keywords: circulating tumor cell; prognosis; prophylactic cranial irradiation; small-cell lung cancer