Circulating tumor cells correlate with recurrence in stage III small-cell lung cancer after systemic chemoradiotherapy and prophylactic cranial irradiation.

Abstract

OBJECTIVE:

We investigated the correlation between circulating tumor cells and the incidence of brain metastases as a first site of recurrence among patients with small-cell lung cancer after systemic chemoradiotherapy and prophylactic cranial irradiation. In addition, we assessed the contribution of circulating tumor cells for planning the appropriate total dose of prophylactic cranial irradiation for small-cell lung cancer.

METHODS:

Patients (n = 112) with diagnosed Stage III small-cell lung cancer were treated with four cycles of platinum-based regimen and concurrent chest irradiation, and then prophylactic cranial irradiation. Blood samples for circulating tumor cell analysis were obtained before the initiation of chemotherapy and after the first and fourth cycle of chemotherapy.

RESULTS:

Circulating tumor cells after the first cycle of chemotherapy correlated with tumor response after completion of chemotherapy (P = 0.012). Patients with brain as the first site suffered a higher rate of further metastases to other organs, and local recurrence, compared with those whose first site was the other organs (P < 0.001), and their survival rates were worse. Circulating tumor cells at baseline were the sole independent prognostic factor for specific progression-free survival. Receiver operating characteristic curves based on median specific progression-free survival revealed a circulating tumor cell cutoff at baseline of 218, and circulating tumor cells ≤218 at baseline correlated with significantly higher progression-free survival (P = 0.007), specific progression-free survival (P = 0.001) and overall survival (P = 0.001).

CONCLUSIONS:

Circulating tumor cells prior to the initiation of chemotherapy are a valuable predictor of specific progression-free survival in Stage III small-cell lung cancer. For patients with circulating tumor cells >218, prophylactic cranial irradiation at a total dose of 30 Gy in 15 fractions is insufficient.

• Authors: Lei Fu, Fang Liu, Hui Fu, Liqing Liu, Shuanghu Yuan, Yongsheng Gao, Zheng Fu, Jinming Yu
• Journal: Japanese journal of clinical oncology (Jpn J Clin Oncol) Vol. 44 Issue 10 Pg. 948-55 (Oct 2014) ISSN: 1465-3621 [Electronic] England
• PMID: 25135984 (Publication Type: Journal Article)
• Copyright: © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected].

Topics

• Aged
• Asian People (statistics & numerical data)
• Brain Neoplasms (epidemiology, prevention & control, secondary)
• Carcinoma, Small Cell (epidemiology, prevention & control, secondary, therapy)
• Chemoradiotherapy
• China (epidemiology)
• Cranial Irradiation
• Disease-Free Survival
• Female
• Humans
• Kaplan-Meier Estimate
• Lung Neoplasms (epidemiology, pathology, therapy)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (prevention & control)
• Neoplasm Staging
• Neoplastic Cells, Circulating
• Treatment Outcome