Primary analysis of a phase II randomized trial radiation therapy Oncology Group (RTOG) 0212: Impact of different total doses and schedules of prophylactic cranial irradiation on chronic neurotoxicity and quality of life for patients with limited-disease small-cell lung cancer

Aaron H. Wolfson, Kyounghwa Bae, Ritsuko Komaki, Christina Meyers, Benjamin Movsas, Cecile Le Pechoux, Maria Werner-Wasik, Gregory M M Videtic, Yolanda I. Garces, Hak Choy

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Abstract

Purpose: To determine the effect of dose and fractionation schedule of prophylactic cranial irradiation (PCI) on the incidence of chronic neurotoxicity (CNt) and changes in quality of life for selected patients with limited-disease small-cell lung cancer (LD SCLC). Methods and Materials: Patients with LD SCLC who achieved a complete response after chemotherapy and thoracic irradiation were eligible for randomization to undergo PCI to a total dose of 25 Gy in 10 daily fractions (Arm 1) vs. the experimental cohort of 36 Gy. Those receiving 36 Gy underwent a secondary randomization between daily 18 fractions (Arm 2) and twice-daily 24 fractions (Arm 3). Enrolled patients participated in baseline and follow-up neuropsychological test batteries along with quality-of-life assessments. Results: A total of 265 patients were accrued, with 131 in Arm 1, 67 in Arm 2, and 66 in Arm 3 being eligible. There are 112 patients (42.2%) alive with 25.3 months of median follow-up. There were no significant baseline differences among groups regarding quality-of-life measures and one of the neuropsychological tests, namely the Hopkins Verbal Learning Test. However, at 12 months after PCI there was a significant increase in the occurrence of CNt in the 36-Gy cohort (p = 0.02). Logistic regression analysis revealed increasing age to be the most significant predictor of CNt (p = 0.005). Conclusions: Because of the increased risk of developing CNt in study patients with 36 Gy, a total PCI dose of 25 Gy remains the standard of care for patients with LD SCLC attaining a complete response to initial chemoradiation.

Original languageEnglish (US)
Pages (from-to)77-84
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume81
Issue number1
DOIs
StatePublished - Sep 1 2011

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Cranial Irradiation
Radiation Oncology
Small Cell Lung Carcinoma
schedules
lungs
radiation therapy
Appointments and Schedules
Radiotherapy
cancer
Quality of Life
dosage
irradiation
Neuropsychological Tests
Random Allocation
Dose Fractionation
Verbal Learning
logistics
chemotherapy
Standard of Care
fractionation

Keywords

  • Chronic neurotoxicity
  • Limited-disease small-cell lung cancer
  • Neuropsychological testing
  • Prophylactic cranial irradiation
  • Quality of life

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Primary analysis of a phase II randomized trial radiation therapy Oncology Group (RTOG) 0212 : Impact of different total doses and schedules of prophylactic cranial irradiation on chronic neurotoxicity and quality of life for patients with limited-disease small-cell lung cancer. / Wolfson, Aaron H.; Bae, Kyounghwa; Komaki, Ritsuko; Meyers, Christina; Movsas, Benjamin; Le Pechoux, Cecile; Werner-Wasik, Maria; Videtic, Gregory M M; Garces, Yolanda I.; Choy, Hak.

In: International Journal of Radiation Oncology Biology Physics, Vol. 81, No. 1, 01.09.2011, p. 77-84.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine the effect of dose and fractionation schedule of prophylactic cranial irradiation (PCI) on the incidence of chronic neurotoxicity (CNt) and changes in quality of life for selected patients with limited-disease small-cell lung cancer (LD SCLC). Methods and Materials: Patients with LD SCLC who achieved a complete response after chemotherapy and thoracic irradiation were eligible for randomization to undergo PCI to a total dose of 25 Gy in 10 daily fractions (Arm 1) vs. the experimental cohort of 36 Gy. Those receiving 36 Gy underwent a secondary randomization between daily 18 fractions (Arm 2) and twice-daily 24 fractions (Arm 3). Enrolled patients participated in baseline and follow-up neuropsychological test batteries along with quality-of-life assessments. Results: A total of 265 patients were accrued, with 131 in Arm 1, 67 in Arm 2, and 66 in Arm 3 being eligible. There are 112 patients (42.2{\%}) alive with 25.3 months of median follow-up. There were no significant baseline differences among groups regarding quality-of-life measures and one of the neuropsychological tests, namely the Hopkins Verbal Learning Test. However, at 12 months after PCI there was a significant increase in the occurrence of CNt in the 36-Gy cohort (p = 0.02). Logistic regression analysis revealed increasing age to be the most significant predictor of CNt (p = 0.005). Conclusions: Because of the increased risk of developing CNt in study patients with 36 Gy, a total PCI dose of 25 Gy remains the standard of care for patients with LD SCLC attaining a complete response to initial chemoradiation.",
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AU - Bae, Kyounghwa

AU - Komaki, Ritsuko

AU - Meyers, Christina

AU - Movsas, Benjamin

AU - Le Pechoux, Cecile

AU - Werner-Wasik, Maria

AU - Videtic, Gregory M M

AU - Garces, Yolanda I.

AU - Choy, Hak

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