Phase III trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer: Neurocognitive and quality-of-life analysis

Alexander Sun, Kyounghwa Bae, Elizabeth M. Gore, Benjamin Movsas, Stuart J. Wong, Christina A. Meyers, James A. Bonner, Steven E. Schild, Laurie E. Gaspar, Jeffery A. Bogart, Maria Werner-Wasik, Hak Choy

Research output: Contribution to journalArticle

213 Citations (Scopus)

Abstract

Purpose: There are scant data regarding the effects of prophylactic cranial irradiation (PCI) on neurocognitive function (NCF) and quality of life (QOL). Radiation Therapy Oncology Group trial 0214 showed no overall survival (OS) benefit for PCI in stage III non-small-cell lung cancer (NSCLC) at 1 year. However, there was a significant decrease in brain metastases (BM). This analysis focuses on the impact of PCI on NCF and QOL. Patients and Methods: Patients with stage III NSCLC who completed definitive therapy without progression were randomly assigned to PCI or observation. NCF was assessed with Mini-Mental Status Examination (MMSE), Activities of Daily Living Scale (ADLS), and Hopkins Verbal Learning Test (HVLT). QOL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) core tool (QOL Questionnaire-QLQC30) and brain module (QLQBN20). Results: There were no statistically significant differences at 1 year between the two arms in any component of the EORTC-QLQC30 or QLQBN20 (P > .05), although a trend for greater decline in patient-reported cognitive functioning with PCI was noted. There were no significant differences in MMSE (P = .60) or ADLS (P = .88). However, for HVLT, there was greater decline in immediate recall (P = .03) and delayed recall (P = .008) in the PCI arm at 1 year. Conclusion: PCI in stage III NSCLC significantly decreases the risk of BM without improving 1-year OS. There were no significant differences in global cognitive function (MMSE) or QOL after PCI, but there was a significant decline in memory (HVLT) at 1 year. This study provides prospective data regarding the relative risks and benefits of PCI in this setting and the need to use sensitive cognitive assessments.

Original languageEnglish (US)
Pages (from-to)279-286
Number of pages8
JournalJournal of Clinical Oncology
Volume29
Issue number3
DOIs
StatePublished - Jan 20 2011

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Cranial Irradiation
Non-Small Cell Lung Carcinoma
Quality of Life
Observation
Verbal Learning
Activities of Daily Living
Brain
Neoplasm Metastasis
Radiation Oncology
Survival
Short-Term Memory
Cognition
Radiotherapy
Organizations
Prospective Studies

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Phase III trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer : Neurocognitive and quality-of-life analysis. / Sun, Alexander; Bae, Kyounghwa; Gore, Elizabeth M.; Movsas, Benjamin; Wong, Stuart J.; Meyers, Christina A.; Bonner, James A.; Schild, Steven E.; Gaspar, Laurie E.; Bogart, Jeffery A.; Werner-Wasik, Maria; Choy, Hak.

In: Journal of Clinical Oncology, Vol. 29, No. 3, 20.01.2011, p. 279-286.

Research output: Contribution to journalArticle

Sun, Alexander ; Bae, Kyounghwa ; Gore, Elizabeth M. ; Movsas, Benjamin ; Wong, Stuart J. ; Meyers, Christina A. ; Bonner, James A. ; Schild, Steven E. ; Gaspar, Laurie E. ; Bogart, Jeffery A. ; Werner-Wasik, Maria ; Choy, Hak. / Phase III trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer : Neurocognitive and quality-of-life analysis. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 3. pp. 279-286.
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abstract = "Purpose: There are scant data regarding the effects of prophylactic cranial irradiation (PCI) on neurocognitive function (NCF) and quality of life (QOL). Radiation Therapy Oncology Group trial 0214 showed no overall survival (OS) benefit for PCI in stage III non-small-cell lung cancer (NSCLC) at 1 year. However, there was a significant decrease in brain metastases (BM). This analysis focuses on the impact of PCI on NCF and QOL. Patients and Methods: Patients with stage III NSCLC who completed definitive therapy without progression were randomly assigned to PCI or observation. NCF was assessed with Mini-Mental Status Examination (MMSE), Activities of Daily Living Scale (ADLS), and Hopkins Verbal Learning Test (HVLT). QOL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) core tool (QOL Questionnaire-QLQC30) and brain module (QLQBN20). Results: There were no statistically significant differences at 1 year between the two arms in any component of the EORTC-QLQC30 or QLQBN20 (P > .05), although a trend for greater decline in patient-reported cognitive functioning with PCI was noted. There were no significant differences in MMSE (P = .60) or ADLS (P = .88). However, for HVLT, there was greater decline in immediate recall (P = .03) and delayed recall (P = .008) in the PCI arm at 1 year. Conclusion: PCI in stage III NSCLC significantly decreases the risk of BM without improving 1-year OS. There were no significant differences in global cognitive function (MMSE) or QOL after PCI, but there was a significant decline in memory (HVLT) at 1 year. This study provides prospective data regarding the relative risks and benefits of PCI in this setting and the need to use sensitive cognitive assessments.",
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T1 - Phase III trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer

T2 - Neurocognitive and quality-of-life analysis

AU - Sun, Alexander

AU - Bae, Kyounghwa

AU - Gore, Elizabeth M.

AU - Movsas, Benjamin

AU - Wong, Stuart J.

AU - Meyers, Christina A.

AU - Bonner, James A.

AU - Schild, Steven E.

AU - Gaspar, Laurie E.

AU - Bogart, Jeffery A.

AU - Werner-Wasik, Maria

AU - Choy, Hak

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N2 - Purpose: There are scant data regarding the effects of prophylactic cranial irradiation (PCI) on neurocognitive function (NCF) and quality of life (QOL). Radiation Therapy Oncology Group trial 0214 showed no overall survival (OS) benefit for PCI in stage III non-small-cell lung cancer (NSCLC) at 1 year. However, there was a significant decrease in brain metastases (BM). This analysis focuses on the impact of PCI on NCF and QOL. Patients and Methods: Patients with stage III NSCLC who completed definitive therapy without progression were randomly assigned to PCI or observation. NCF was assessed with Mini-Mental Status Examination (MMSE), Activities of Daily Living Scale (ADLS), and Hopkins Verbal Learning Test (HVLT). QOL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) core tool (QOL Questionnaire-QLQC30) and brain module (QLQBN20). Results: There were no statistically significant differences at 1 year between the two arms in any component of the EORTC-QLQC30 or QLQBN20 (P > .05), although a trend for greater decline in patient-reported cognitive functioning with PCI was noted. There were no significant differences in MMSE (P = .60) or ADLS (P = .88). However, for HVLT, there was greater decline in immediate recall (P = .03) and delayed recall (P = .008) in the PCI arm at 1 year. Conclusion: PCI in stage III NSCLC significantly decreases the risk of BM without improving 1-year OS. There were no significant differences in global cognitive function (MMSE) or QOL after PCI, but there was a significant decline in memory (HVLT) at 1 year. This study provides prospective data regarding the relative risks and benefits of PCI in this setting and the need to use sensitive cognitive assessments.

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