Advance of prophylactic cranial irradiation in lung cancer

Brain metastases in patients with lung cancer are a devastating problem with profound impact on survival. Prophylactic cranial irradiation has been discussed as an option to reduce the risk of brain metastases. This report provides an extensive review of the current evidence from non-randomized and randomized trials regarding the use of prophylactic cranial irradiation in lung cancer.

Long-term results of prophylactic cranial irradiation for limited-stage small-cell lung cancer in complete remission

Background Brain metastasis is one of the most important causes of treatment failure in patients with small cell lung cancer （SCLC）. This study was conducted to evaluate the effects of prophylactic cranial irradiation （PCI） on survival and brain metastases for patients with limited stage small cell lung cancer in complete remission. Methods Fifty one patients with limited stage SCLC in complete remission after chemoradiotherapy were randomly divided into PCI group （n = 26） and control group （n = 25 ）. Patients in the PCI group received PCI at a dose of 25.2 to 30. 6 Gy in 1.8 to 2.0 Gy per fraction. The Kaplan-Meier method and Log rank test were used to analyse and compare survival rates, and X^2 test was used to compare the incidences of cranial metastases in two groups. Results There was no significant difference in clinical characteristics of patients such as age, sex, effect of treatment before PCI between the two groups. The incidence of brain metastases was 3.8% in the PCI group in contrast to 32. 0% in the control group （X^2 =5.15, P =0. 02）. The 1, 3, 5-year survival rates were 84. 6%, 42. 3%, 34. 6% respectively in the PCI group and 72.0%, 32. 0%, 24. 0% respectively in the control group, with no difference between the two groups （X^2 = 2. 25, P = 0. 13 ）. No serious sequelae were observed in patients receiving PCI. Conclusion For patients with limited stage SCLC responding completely to chemotherapy plus radiotherapy, PCI can decrease the incidence of brain metastases and improve survival rate.

Prognostic factors for patients with limited-stage small-cell lung cancer without receiving prophylactic cranial irradiation

Objective:This retrospective study aims to explore the risk factors for brain metastasis and the prognostic factors for overall survival(OS)in patients with limited-stage small-cell lung cancer(LS-SCLC)who have no brain metastases according to magnetic resonance imaging(MRI)and have not received prophylactic cranial irradiation(PCI)after first-line chemoradiotherapy.Methods:A total of 107 patients who were treated in the Fourth Hospital of Hebei Medical University from January 2013 to December 2017 were enrolled in this study.The patients were treated with etoposide/platinum chemotherapy and thoracic radiotherapy(TRT)with involved-field irradiation.The median dose of the radiotherapy was 60 Gy(50-64 Gy).The primary study endpoints include BMFS(brain-metastasis-free survival)and OS(overall survival).The Kaplan-Meier method was applied to estimate survival,with a log-rank test used to ascertain statistical significance.The multivariate Cox proportional hazards model was used to determine the prognostic factors for survival.Results:The median follow-up of all patients was 18.8 months(range:7.9–65.1 months)and the median follow-up of surviving patients was 26.7 months(range:18.8–65.1 months).The median OS of the whole cohort was 20.1 months,and the 1-,2-and 3-year OS rates were 84.9%,44.9%,and 25.9%,respectively.The 1-,2-,and 3-year BMFS rates were 69.0%,49.9%,and 40.7%,respectively.50 patients(46.7%)developed brain metastases during the follow-up period,and the median time from the start to brain metastasis was 10.7 months(range:4.8–31.1 months).As shown by multivariate analysis,independent prognostic factors of OS included cycles of chemotherapy(P=0.019),the response to initial treatment(P=0.011),and the start time of TRT(P=0.044).The independent prognostic factors of BMFS included the clinical stage(P=0.008),the response to initial treatment(P=0.024),and the start time of TRT(P=0.028).Conclusions:For patients with LS-SCLC who have not received PCI,favorable factors for lower brain metastasis and higher survival include early clinical stage,CR to initial chemoradiotherapy,early TRT,and adequate cycles of chemotherapy.PCI is still recommended as the standard modality since the incidence of brain metastases was high(46.7%).

Concurrent chemotherapy and reduced - dose cranial spinal irradiation followed by conformal posterior fossa tumor bed boost for average - risk medulloblastoma: efficacy and patterns of failure

PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional

Active fraction combination from Liuwei Dihuang decoction improves adult hippocampal neurogenesis and neurogenic microenvironment in cranially irradiated mice

OBJECTIVE Cranial radiotherapy is clinically used in the treatment of brain tumors;however,the consequent cognitive and emotional dysfunctions seriously impair the life quality of patients.LW-AFC,an active fraction combination extracted from classical traditional Chinese medicine prescription Liuwei Dihuang decoction,can improve cognitive and emotional dysfunctions in many animal models;however,the protective effect of LW-AFC on cranial irradiation-induced cognitive and emotional dysfunctions has not been reported.Recent studies indicate that impairment of adult hippocampal neurogenesis(AHN)and alterations of the neurogenic microenvironment in the hippocampus constitute critical factors in cognitive and emotional dysfunctions following cranial irradiation.Here,our research further investigated the potential protective effects and mechanisms of LW-AFC on cranial irradiation-induced cognitive and emotional dysfunctions in mice.METHODS LW-AFC(1.6 g·kg^(-1))was intragastrically administered to mice for 14 d before cranial irradiation(7 Gyγ-ray).AHN was examined by quantifying the number of proliferative neural stem cells and immature neurons in the dorsal and ventral hippocampus.The contextual fear conditioning test,open field test,and tail suspension test were used to assess cognitive and emotional functions in mice.To detect the change of the neurogenic microenvironment,colorimetry and multiplex bead analysis were performed to measure the level of oxidative stress,neurotrophic and growth factors,and inflammation in the hippocampus.RESULTS LW-AFC exerted beneficial effects on the contextual fear memory,anxiety behavior,and depression behavior in irradiated mice.Moreover,LW-AFC increased the number of proliferative neural stem cells and immature neurons in the dorsal hippocampus,displaying a regional specificity of neurogenic response.For the neurogenic microenvironment,LW-AFC significantly increased the contents of superoxide dismutase,glutathione peroxidase,glutathione,and catalase and decreased the content of malondialdehyde in the hippocampus of irradiated mice,accompanied by the increase in brain-derived neurotrophic factor,insulin-like growth factor-1,and interleukin-4 content.Together,LW-AFC improved cognitive and emotional dysfunctions,promoted AHN preferentially in the dorsal hippocampus,and ameliorated disturbance in the neurogenic microenvironment in irradiated mice.CONCLUSION LW-AFC ameliorates cranial irradiation-induced cognitive and emotional dysfunctions,and the underlying mechanisms are mediated by promoting AHN in the dorsal hippocampus and improving the neurogenic microenvironment.LW-AFC might be a promising therapeutic agent to treat cognitive and emotional dysfunctions in patients receiving cranial radiotherapy.

New perspectives in the management of small cell lung cancer

The treatment of small cell lung cancer(SCLC)is a challenge for all specialists involved.New treatments have been added to the therapeutic armamentarium in recent months,but efforts must continue to improve both survival and quality of life.Advances in surgery and radiotherapy have resulted in prolonged survival times and fewer complications,while more careful patient selection has led to increased staging accuracy.Developments in the field of systemic therapy have resulted in changes to clinical guidelines and the management of patients with advanced disease,mainly with the introduction of immunotherapy.In this article,we describe recent improvements in the management of patients with SCLC,review current treatments,and discuss future lines of research.

Stroke-like Migraine Attacks after Radiation Therapy Syndrome

Objective：To summarize the clinical presentation,pathogenesis,neuroimaging,treatment,and outcome of stroke-like migraine attacks after radiation therapy （SMART） syndrome,and to propose diagnostic criteria for this disorder.Data Sources：We searched the PubMed database for articles in English published from 1995 to 2015 using the terms of ＂stroke-like AND migraine AND radiation.＂ Reference lists of the identified articles and reviews were used to retrieve additional articles.Study Selection：Data and articles related to late-onset effects of cerebral radiation were selected and reviewed.Results：SMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies.The recovery,which ranges from hours to days to weeks,can be partial or complete.We propose the following diagnostic criteria for SMART：（1） Remote history of therapeutic external beam cranial irradiation for malignancy;（2） prolonged,reversible clinical manifestations mostly years after irradiation,which may include migraine,seizures,hemiparesis,hemisensory deficits,visuospatial defect,aphasia,confusion and so on;（3） reversible,transient,unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region;（4） eventual complete or partial recovery,the length of duration of recovery ranging from hours to days to weeks;（5） no evidence of residual or recurrent tumor;（6） not attributable to another disease.To date,no specific treatment has been identified for this syndrome.Conclusions：SMART is an extremely rare delayed complication of brain irradiation.However,improvements in cancer survival rates have resulted in a rise in its frequency.Hence,awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.