Time Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis

Purpose: Patients with small cell lung cancer (SCLC) who have brain metastases require whole-brain radiation therapy (WBRT). When there is no emergent indication for WBRT, patients may receive systemic therapy first and WBRT afterward. In scenarios when systemic therapy is initiated first, it has no...

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Autores principales:	Neil Chevli, MD, Andrew Hunt, MD, Waqar Haque, MD, Andrew M. Farach, MD, Jay A. Messer, MD, Suporn Sukpraprut-Braaten, PhD, Eric H. Bernicker, MD, Jun Zhang, MD, E. Brian Butler, MD, Bin S. Teh, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/23b77eca786246599871a488f00203c1
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spelling	oai:doaj.org-article:23b77eca786246599871a488f00203c12021-11-14T04:34:46ZTime Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis2452-109410.1016/j.adro.2021.100783https://doaj.org/article/23b77eca786246599871a488f00203c12021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S245210942100141Xhttps://doaj.org/toc/2452-1094Purpose: Patients with small cell lung cancer (SCLC) who have brain metastases require whole-brain radiation therapy (WBRT). When there is no emergent indication for WBRT, patients may receive systemic therapy first and WBRT afterward. In scenarios when systemic therapy is initiated first, it has not been previously investigated whether delaying WBRT is harmful. Methods and Materials: The National Cancer Database was queried (2004-2016) for patients with SCLC with brain metastases who received 30 Gy in 10 fractions of WBRT. Patients were divided into groups based on whether they received early WBRT (3-14 days after initiation of chemotherapy) or late WBRT (15-90 days after initiation of chemotherapy). Demographic and clinicopathologic categorical variables were compared between those who had early WBRT (3-14 days) and those who had late WBRT (15-90 days). Factors predictive for late WBRT were determined. Overall survival (OS), which was defined as days from diagnosis to death, was evaluated and variables prognostic for OS were determined. Results: A total of 1082 patients met selection criteria; 587 (54%) had early WBRT and 495 (46%) received late WBRT. Groups were similarly distributed aside from days from initiating chemotherapy to initiating WBRT (P < .001). The early WBRT group had a median of 7 days (interquartile range [IQR], 5-10 days) from initiating chemotherapy to initiating WBRT and the late WBRT group had a median of 34 days (IQR, 21-57 days). On binary logistic regression analysis, a longer time interval between diagnosis and the start of systemic therapy was predictive for later WBRT. Median OS was 8.7 months for early WBRT and 7.5 months for late WBRT (hazard ratio [HR], 1.165; P = .008). Early WBRT (P = .02), female sex (P = .045), and private insurance (P = .04) were favorable prognostic factors for OS on multivariable analysis, whereas older age (P = .006) was an unfavorable prognostic factor. Conclusions: Patients with SCLC and brain metastases who received early WBRT were found to have a modest improvement in OS compared with patients who received late WBRT. These findings suggest that early WBRT should be offered to patients who have brain metastases, even in the absence of an indication for emergent WBRT.Neil Chevli, MDAndrew Hunt, MDWaqar Haque, MDAndrew M. Farach, MDJay A. Messer, MDSuporn Sukpraprut-Braaten, PhDEric H. Bernicker, MDJun Zhang, MDE. Brian Butler, MDBin S. Teh, MDElsevierarticleMedical physics. Medical radiology. Nuclear medicineR895-920Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENAdvances in Radiation Oncology, Vol 6, Iss 6, Pp 100783- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Neil Chevli, MD Andrew Hunt, MD Waqar Haque, MD Andrew M. Farach, MD Jay A. Messer, MD Suporn Sukpraprut-Braaten, PhD Eric H. Bernicker, MD Jun Zhang, MD E. Brian Butler, MD Bin S. Teh, MD Time Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis
description	Purpose: Patients with small cell lung cancer (SCLC) who have brain metastases require whole-brain radiation therapy (WBRT). When there is no emergent indication for WBRT, patients may receive systemic therapy first and WBRT afterward. In scenarios when systemic therapy is initiated first, it has not been previously investigated whether delaying WBRT is harmful. Methods and Materials: The National Cancer Database was queried (2004-2016) for patients with SCLC with brain metastases who received 30 Gy in 10 fractions of WBRT. Patients were divided into groups based on whether they received early WBRT (3-14 days after initiation of chemotherapy) or late WBRT (15-90 days after initiation of chemotherapy). Demographic and clinicopathologic categorical variables were compared between those who had early WBRT (3-14 days) and those who had late WBRT (15-90 days). Factors predictive for late WBRT were determined. Overall survival (OS), which was defined as days from diagnosis to death, was evaluated and variables prognostic for OS were determined. Results: A total of 1082 patients met selection criteria; 587 (54%) had early WBRT and 495 (46%) received late WBRT. Groups were similarly distributed aside from days from initiating chemotherapy to initiating WBRT (P < .001). The early WBRT group had a median of 7 days (interquartile range [IQR], 5-10 days) from initiating chemotherapy to initiating WBRT and the late WBRT group had a median of 34 days (IQR, 21-57 days). On binary logistic regression analysis, a longer time interval between diagnosis and the start of systemic therapy was predictive for later WBRT. Median OS was 8.7 months for early WBRT and 7.5 months for late WBRT (hazard ratio [HR], 1.165; P = .008). Early WBRT (P = .02), female sex (P = .045), and private insurance (P = .04) were favorable prognostic factors for OS on multivariable analysis, whereas older age (P = .006) was an unfavorable prognostic factor. Conclusions: Patients with SCLC and brain metastases who received early WBRT were found to have a modest improvement in OS compared with patients who received late WBRT. These findings suggest that early WBRT should be offered to patients who have brain metastases, even in the absence of an indication for emergent WBRT.
format	article
author	Neil Chevli, MD Andrew Hunt, MD Waqar Haque, MD Andrew M. Farach, MD Jay A. Messer, MD Suporn Sukpraprut-Braaten, PhD Eric H. Bernicker, MD Jun Zhang, MD E. Brian Butler, MD Bin S. Teh, MD
author_facet	Neil Chevli, MD Andrew Hunt, MD Waqar Haque, MD Andrew M. Farach, MD Jay A. Messer, MD Suporn Sukpraprut-Braaten, PhD Eric H. Bernicker, MD Jun Zhang, MD E. Brian Butler, MD Bin S. Teh, MD
author_sort	Neil Chevli, MD
title	Time Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis
title_short	Time Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis
title_full	Time Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis
title_fullStr	Time Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis
title_full_unstemmed	Time Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis
title_sort	time interval to initiation of whole-brain radiation therapy in patients with small cell lung cancer with brain metastasis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/23b77eca786246599871a488f00203c1
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Time Interval to Initiation of Whole-Brain Radiation Therapy in Patients With Small Cell Lung Cancer With Brain Metastasis

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