Decision Analysis for Prophylactic Cranial Irradiation for Patients With Small-Cell Lung Cancer

• Published in: Journal of clinical oncology Vol. 24; no. 22; pp. 3597 - 3603
• Main Authors: Lee, J. Jack, Bekele, B. Nebiyou, Zhou, Xian, Cantor, Scott B., Komaki, Ritsuko, Lee, Jin Soo
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.08.2006; Lippincott Williams & Wilkins
• Subjects: Biological and medical sciences; Brain Neoplasms - prevention & control; Brain Neoplasms - secondary; Carcinoma, Small Cell - prevention & control; Carcinoma, Small Cell - secondary; Cranial Irradiation; Decision Support Techniques; Female; Humans; Life Expectancy; Logistic Models; Lung Neoplasms - pathology; Male; Medical sciences; Pneumology; Predictive Value of Tests; Quality of Life; Quality-Adjusted Life Years; Sensitivity and Specificity; Severity of Illness Index; Survival Analysis; Tumors; Tumors of the respiratory system and mediastinum; Human; Prevention; Lung disease; Cancerology; Respiratory disease; Lung cancer; Bonchopulmonary small cell carcinoma; Irradiation; Bronchus disease; Malignant tumor; Decision analysis
• ISSN: 0732-183X; 1527-7755; 1527-7755
• DOI: 10.1200/JCO.2006.06.0632

Prophylactic cranial irradiation (PCI) has been shown to provide survival benefit in patients with limited disease small-cell lung cancer (LD-SCLC) who have achieved complete response. However, PCI may also produce long-term neurotoxicity (NT). The benefits and risks of PCI in LD-SCLC are evaluated. We developed a decision-analytic model to compare quality-adjusted life expectancy (QALE) in a cohort of SCLC patients who do or do not receive PCI by varying survival rates and the frequency and severity of PCI-related NT. Sensitivity analyses were applied to examine the robustness of the optimal decision. At current published survival rates (26% 5-year survival rate with PCI and 22% without PCI) and a low NT rate, PCI offered a benefit over no PCI (QALE = 4.31 and 3.70 for mild NT severity; QALE = 4.09 and 3.70 for substantial NT severity, respectively). With a moderate NT rate, PCI was still preferred. If the PCI survival rate increased to 40%, PCI outperformed no PCI with a mild NT severity. However, no PCI was preferred over PCI (QALE = 5.72 v 5.47) with substantial NT severity. Two-way sensitivity analyses showed that PCI was preferred for low NT rates, mild NT severity, and low long-term survival rates. Otherwise, no PCI was preferred. The current data suggest PCI offers better QALE than no PCI in LD-SCLC patients who have achieved complete response. As the survival rate for SCLC patients continues to improve, NT rate and NT severity must be controlled to maintain a favorable benefit-risk ratio for recommending PCI.