title: Risk factors for brain metastases in completely resected small cell lung cancer: a retrospective study to identify patients most likely to benefit from prophylactic cranial irradiation.
abstract: BACKGROUND
  The role of prophylactic cranial irradiation (PCI) on small cell lung cancer (SCLC) has been established based on the two-stage system of limited versus extensive disease and the treatment modality of chemoradiotherapy. However, the use of PCI after combined-modality treatment with surgery for resectable limited-stage SCLC has not been investigated sufficiently. We conducted a retrospective study to evaluate risk factors for brain metastasis (BM) in patients with surgically resected SCLC to identify those most likely to benefit from PCI.
  
  
  METHODS
  The records of 126 patients with completely resected SCLC and definitive TNM stage based on histological examination between 2003 and 2009 were reviewed. The cumulative incidence of BM was estimated using the Kaplan-Meier method and differences between the groups were analyzed using the log-rank test. Multivariate Cox regression analysis was applied to assess the risk factors of BM.
  
  
  RESULTS
  Twenty-eight patients (22.2%) developed BM at some point during their clinical course. The actuarial risk of developing BM at 3 years was 9.7% in patients with p-stage I disease, 18.5% in patients with p-stage II disease, and 35.4% in patients with p-stage III disease (p = 0.013). The actuarial risk of developing BM at 3 years in patients with LVI was 39.9% compared to 17.5% in patients without LVI (p = 0.003). Multivariate analysis identified pathologic stage (hazard ratio [HR] = 2.013, p = 0.017) and LVI (HR = 1.924, p = 0.039) as independent factors related to increased risk of developing BM.
  
  
  CONCLUSIONS
  Patients with completely resected p-stage II-III SCLC and LVI are at the highest risk for BM.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.forename: Yongmin
authors.initials: Y
authors.lastname: Bi
authors.forename: Anqin
authors.initials: A
authors.lastname: Han
authors.forename: Jingyu
authors.initials: J
authors.lastname: Luo
authors.forename: Minghuan
authors.initials: M
authors.lastname: Li
authors.forename: Fang
authors.initials: F
authors.lastname: Shi
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jiyan Rd, 440, Jinan 250117, Shandong Province, China. kongli7@sina.com.
authors.forename: Li
authors.initials: L
authors.lastname: Kong
authors.forename: Jinming
authors.initials: J
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control* / Q000556:secondary*; D016371:Cranial Irradiation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*