Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer

Survey of US Radiation Oncologists on Current Practice Patterns

Matthew J. Farrell, Jehan B. Yahya, Catherine Degnin, Yiyi Chen, John Holland, Mark A. Henderson, Jerry Jaboin, Matthew M. Harkenrider, Charles Thomas, Timur Mitin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

In this survey of 309 practicing US radiation oncologists, almost all respondents recommended prophylactic cranial irradiation (PCI) and pre-PCI brain magnetic resonance imaging (MRI)—practices endorsed by national guidelines. Only a third followed their patients with serial brain MRI after PCI, and about one third recommended memantine for patients undergoing PCI. This survey establishes a practice-pattern baseline for future clinical trials. Purpose: Prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (LS-SCLC) is considered the standard of care. Meta-analysis of 7 clinical trials indicates a survival benefit to PCI, but all of these trials were conducted in the pre–magnetic resonance imaging (MRI) era. Therefore, routine brain imaging with MRI before PCI—as recommended by National Comprehensive Cancer Network guidelines—is not directly supported by the evidence. Current US practice patterns for patients with LS-SCLC are unknown. Materials and Methods: We surveyed practicing US radiation oncologists via an institutional review board–approved online questionnaire. Questions covered demographic information and treatment recommendations for LS-SCLC. Results: We received 309 responses from US radiation oncologists. Ninety-eight percent recommended PCI for patients with LS-SCLC, 96% obtained brain MRI before PCI, 33% obtained serial brain imaging with MRI after PCI to detect new metastases, and 35% recommended memantine for patients undergoing PCI. Recommending memantine was associated with fewer years of postresidency training (P <.001), fewer lung cancer patients treated per year (P =.045), and fewer LS-SCLC patients treated per year (P =.024). Conclusion: Almost all responding radiation oncologists recommended PCI and pre-PCI brain MRI for LS-SCLC patients with disease responsive to initial therapy. Only a third of respondents followed these patients with serial brain MRI. Approximately one third provided memantine therapy to try to limit neurocognitive effects of PCI. Further research is warranted to determine the best treatment for patients with LS-SCLC. This survey can inform the development of future trials that depend on participation from radiation oncologists.

Original languageEnglish (US)
JournalClinical Lung Cancer
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Cranial Irradiation
Small Cell Lung Carcinoma
Magnetic Resonance Imaging
Memantine
Brain
Neuroimaging
Surveys and Questionnaires
Radiation Oncologists
Clinical Trials
Therapeutics
Standard of Care

Keywords

  • Brain magnetic resonance imaging
  • Brain metastasis
  • Memantine
  • Radiotherapy
  • Surveillance

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer : Survey of US Radiation Oncologists on Current Practice Patterns. / Farrell, Matthew J.; Yahya, Jehan B.; Degnin, Catherine; Chen, Yiyi; Holland, John; Henderson, Mark A.; Jaboin, Jerry; Harkenrider, Matthew M.; Thomas, Charles; Mitin, Timur.

In: Clinical Lung Cancer, 01.01.2018.

Research output: Contribution to journalArticle

@article{1eaf725ca2d044e29bb3e181cd70d958,
title = "Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer: Survey of US Radiation Oncologists on Current Practice Patterns",
abstract = "In this survey of 309 practicing US radiation oncologists, almost all respondents recommended prophylactic cranial irradiation (PCI) and pre-PCI brain magnetic resonance imaging (MRI)—practices endorsed by national guidelines. Only a third followed their patients with serial brain MRI after PCI, and about one third recommended memantine for patients undergoing PCI. This survey establishes a practice-pattern baseline for future clinical trials. Purpose: Prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (LS-SCLC) is considered the standard of care. Meta-analysis of 7 clinical trials indicates a survival benefit to PCI, but all of these trials were conducted in the pre–magnetic resonance imaging (MRI) era. Therefore, routine brain imaging with MRI before PCI—as recommended by National Comprehensive Cancer Network guidelines—is not directly supported by the evidence. Current US practice patterns for patients with LS-SCLC are unknown. Materials and Methods: We surveyed practicing US radiation oncologists via an institutional review board–approved online questionnaire. Questions covered demographic information and treatment recommendations for LS-SCLC. Results: We received 309 responses from US radiation oncologists. Ninety-eight percent recommended PCI for patients with LS-SCLC, 96{\%} obtained brain MRI before PCI, 33{\%} obtained serial brain imaging with MRI after PCI to detect new metastases, and 35{\%} recommended memantine for patients undergoing PCI. Recommending memantine was associated with fewer years of postresidency training (P <.001), fewer lung cancer patients treated per year (P =.045), and fewer LS-SCLC patients treated per year (P =.024). Conclusion: Almost all responding radiation oncologists recommended PCI and pre-PCI brain MRI for LS-SCLC patients with disease responsive to initial therapy. Only a third of respondents followed these patients with serial brain MRI. Approximately one third provided memantine therapy to try to limit neurocognitive effects of PCI. Further research is warranted to determine the best treatment for patients with LS-SCLC. This survey can inform the development of future trials that depend on participation from radiation oncologists.",
keywords = "Brain magnetic resonance imaging, Brain metastasis, Memantine, Radiotherapy, Surveillance",
author = "Farrell, {Matthew J.} and Yahya, {Jehan B.} and Catherine Degnin and Yiyi Chen and John Holland and Henderson, {Mark A.} and Jerry Jaboin and Harkenrider, {Matthew M.} and Charles Thomas and Timur Mitin",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.cllc.2018.02.009",
language = "English (US)",
journal = "Clinical Lung Cancer",
issn = "1525-7304",
publisher = "Elsevier",

}

TY - JOUR

T1 - Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer

T2 - Survey of US Radiation Oncologists on Current Practice Patterns

AU - Farrell, Matthew J.

AU - Yahya, Jehan B.

AU - Degnin, Catherine

AU - Chen, Yiyi

AU - Holland, John

AU - Henderson, Mark A.

AU - Jaboin, Jerry

AU - Harkenrider, Matthew M.

AU - Thomas, Charles

AU - Mitin, Timur

PY - 2018/1/1

Y1 - 2018/1/1

N2 - In this survey of 309 practicing US radiation oncologists, almost all respondents recommended prophylactic cranial irradiation (PCI) and pre-PCI brain magnetic resonance imaging (MRI)—practices endorsed by national guidelines. Only a third followed their patients with serial brain MRI after PCI, and about one third recommended memantine for patients undergoing PCI. This survey establishes a practice-pattern baseline for future clinical trials. Purpose: Prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (LS-SCLC) is considered the standard of care. Meta-analysis of 7 clinical trials indicates a survival benefit to PCI, but all of these trials were conducted in the pre–magnetic resonance imaging (MRI) era. Therefore, routine brain imaging with MRI before PCI—as recommended by National Comprehensive Cancer Network guidelines—is not directly supported by the evidence. Current US practice patterns for patients with LS-SCLC are unknown. Materials and Methods: We surveyed practicing US radiation oncologists via an institutional review board–approved online questionnaire. Questions covered demographic information and treatment recommendations for LS-SCLC. Results: We received 309 responses from US radiation oncologists. Ninety-eight percent recommended PCI for patients with LS-SCLC, 96% obtained brain MRI before PCI, 33% obtained serial brain imaging with MRI after PCI to detect new metastases, and 35% recommended memantine for patients undergoing PCI. Recommending memantine was associated with fewer years of postresidency training (P <.001), fewer lung cancer patients treated per year (P =.045), and fewer LS-SCLC patients treated per year (P =.024). Conclusion: Almost all responding radiation oncologists recommended PCI and pre-PCI brain MRI for LS-SCLC patients with disease responsive to initial therapy. Only a third of respondents followed these patients with serial brain MRI. Approximately one third provided memantine therapy to try to limit neurocognitive effects of PCI. Further research is warranted to determine the best treatment for patients with LS-SCLC. This survey can inform the development of future trials that depend on participation from radiation oncologists.

AB - In this survey of 309 practicing US radiation oncologists, almost all respondents recommended prophylactic cranial irradiation (PCI) and pre-PCI brain magnetic resonance imaging (MRI)—practices endorsed by national guidelines. Only a third followed their patients with serial brain MRI after PCI, and about one third recommended memantine for patients undergoing PCI. This survey establishes a practice-pattern baseline for future clinical trials. Purpose: Prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (LS-SCLC) is considered the standard of care. Meta-analysis of 7 clinical trials indicates a survival benefit to PCI, but all of these trials were conducted in the pre–magnetic resonance imaging (MRI) era. Therefore, routine brain imaging with MRI before PCI—as recommended by National Comprehensive Cancer Network guidelines—is not directly supported by the evidence. Current US practice patterns for patients with LS-SCLC are unknown. Materials and Methods: We surveyed practicing US radiation oncologists via an institutional review board–approved online questionnaire. Questions covered demographic information and treatment recommendations for LS-SCLC. Results: We received 309 responses from US radiation oncologists. Ninety-eight percent recommended PCI for patients with LS-SCLC, 96% obtained brain MRI before PCI, 33% obtained serial brain imaging with MRI after PCI to detect new metastases, and 35% recommended memantine for patients undergoing PCI. Recommending memantine was associated with fewer years of postresidency training (P <.001), fewer lung cancer patients treated per year (P =.045), and fewer LS-SCLC patients treated per year (P =.024). Conclusion: Almost all responding radiation oncologists recommended PCI and pre-PCI brain MRI for LS-SCLC patients with disease responsive to initial therapy. Only a third of respondents followed these patients with serial brain MRI. Approximately one third provided memantine therapy to try to limit neurocognitive effects of PCI. Further research is warranted to determine the best treatment for patients with LS-SCLC. This survey can inform the development of future trials that depend on participation from radiation oncologists.

KW - Brain magnetic resonance imaging

KW - Brain metastasis

KW - Memantine

KW - Radiotherapy

KW - Surveillance

UR - http://www.scopus.com/inward/record.url?scp=85044170827&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044170827&partnerID=8YFLogxK

U2 - 10.1016/j.cllc.2018.02.009

DO - 10.1016/j.cllc.2018.02.009

M3 - Article

JO - Clinical Lung Cancer

JF - Clinical Lung Cancer

SN - 1525-7304

ER -