title: Outcome in patients with small cell lung cancer re-irradiated for brain metastases after prior prophylactic cranial irradiation.
abstract: Patients with brain metastases from small-cell lung cancer (SCLC) who underwent prior prophylactic cranial irradiation (PCI) are often treated with a second course of whole brain radiation therapy (Re-WBRT) or stereotactic radiosurgery (SRS) for purposes of palliation in symptomatic patients, hope for increased life expectancy or even as an alternative to untolerated steroids. Up to date there is only limited data available regarding the effect of this treatment. This study examines outcomes in patients in a single institution who underwent cerebral re-irradiation after prior PCI.
  
  
  
  We examined the medical records of 76 patients with brain metastases who had initially received PCI between 2008 and 2015 and were subsequently irradiated with a second course of cerebral radiotherapy. Patients underwent re-irradiation using either Re-WBRT (88%) or SRS (17%). The outcomes, including symptom palliation, radiation toxicity, and overall survival (OS) following re-irradiation were analyzed. Survival and correlations were calculated using log-rank, univariate, and multivariate Cox proportional hazards-ratio analyses. Treatment-related toxicity was classified according to CTCAE v4.0.
  
  
  
  Median OS of all patients was 3 months (range 0-12 months). Median OS after Re-WBRT was 3 months (range 0-12 months). Median OS after SRS was 5 months (range 0-12 months). Karnofsky performance status scale (KPS ≥50%) was significantly associated with improved OS in both univariate (HR 2772; p=0,009) and multivariate analyses (HR 2613; p=0,024) for patients receiving Re-WBRT. No unexpected toxicity was observed and the observed toxicity remained consistently low. Symptom palliation was achieved in 40% of symptomatic patients.
  
  
  
  In conclusion, cerebral re-irradiation after prior PCI is beneficial for symptom palliation and is associated with minimal side effects in patients with SCLC. Our survival data suggests that it is primarily useful in patients with adequate performance status.
authors: University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. Electronic address: denise.bernhardt@med.uni-heidelberg.de.
authors: Denise
authors: D
authors: Bernhardt
authors: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.
authors: Farastuk
authors: F
authors: Bozorgmehr
authors: University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
authors: Sebastian
authors: S
authors: Adeberg
authors: University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany.
authors: Nils
authors: N
authors: Opfermann
authors: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.
authors: Damian
authors: D
authors: von Eiff
authors: University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany.
authors: Juliane
authors: J
authors: Rieber
authors: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany; Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany.
authors: Jutta
authors: J
authors: Kappes
authors: University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany.
authors: Robert
authors: R
authors: Foerster
authors: University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany.
authors: Laila
authors: L
authors: König
authors: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.
authors: Michael
authors: M
authors: Thomas
authors: University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
authors: Jürgen
authors: J
authors: Debus
authors: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.
authors: Martin
authors: M
authors: Steins
authors: University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany.
authors: Stefan
authors: S
authors: Rieken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000532:radiotherapy*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Brain metastasis; Prophylactic cranial irradiation; Re-irradiation; SCLC; Small cell lung cancer; Stereotactic radiosurgery