Impact of HA-PCI on self-reported cognitive functioning and brain metastases in small-cell lung cancer: Pooled findings of NCT01780675 and PREMER trials

Haiyan Zeng ¹, Sanne B Schagen ², Lizza E L Hendriks ³

¹Department of Radiation Oncology, Division of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), Maastricht, the Netherlands.
²Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
³GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, Department of Pulmonary Diseases, Maastricht, the Netherlands.
⁴Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Barcelona Beta Brain Research Center (BBRC), Pasqual Maragall Foundation. Barcelona, Spain.
⁵Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
⁶Department of Neurology, Hospital del Mar, Barcelona, Spain.
⁷Ghent University Hospital and Ghent University, Radiation Oncology, Gent, Belgium.
⁸Department of Radiation Oncology, Hospital Universitario Sant Joan de Reus. Reus, Tarragona, Spain.
⁹Department of Radiation Oncology, Complejo Hospitalario Navarra, Pamplona, Spain.
¹⁰Department of Radiation Oncology. Hospital Universitario Rey Juan Carlos. Móstoles, Madrid, Spain.
¹¹GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), Maastricht, the Netherlands.
¹²Amsterdam UMC- Location AMC, Radiation Oncology, Amsterdam, the Netherlands.
¹³Radiation Oncology Unit, Instituto de Biomedicina de Sevilla, IBIS, Sevilla, Spain; Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain.
¹⁴Catharina Hospital, Radiation Oncology, Eindhoven, the Netherlands.
¹⁵Genesis Care Madrid Clinical Director. San Francisco de Asís and La Milagrosa Hospitals, Madrid, Spain.
¹⁶Department of Radiation Oncology, Leuven Cancer Institute, UZ Gasthuisberg, Leuven, Belgium.
¹⁷Department of Radiation Oncology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela. A Coruña, Spain.
¹⁸The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Radiation Oncology, Amsterdam, the Netherlands.
¹⁹Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Radiation Oncology, Hospital del Mar, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain.

⁰Department of Radiation Oncology, Division of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), Maastricht, the Netherlands.

Lung +

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November 30, 2024

View abstract on PubMed

Summary

Hippocampal avoidance during PCI did not improve cognitive function in small cell lung cancer patients. This technique also did not increase the risk of brain metastases, suggesting further strategies are needed.

Area Of Science

Oncology
Radiation Oncology
Neuro-oncology

Background

Cognitive decline is a significant concern for patients undergoing cranial irradiation.
Hippocampal avoidance (HA)-PCI aims to mitigate cognitive side effects of PCI.
This study investigates HA-PCI's impact on self-reported cognitive functioning (SRCF) and brain metastases (BM).

Purpose Of The Study

To compare SRCF in patients receiving HA-PCI versus standard PCI.
To assess if HA-PCI increases the incidence of BM within the targeted area.
To evaluate the longitudinal cognitive outcomes and BM development in small cell lung cancer (SCLC) patients.

Main Methods

Pooled data from two phase III trials (NCT01780675, NCT02397733) involving 318 SCLC patients.
Patients were randomized to either PCI or HA-PCI.
SRCF and BM incidence were assessed via MRI up to 24 months; cognitive impairment defined as SRCF < 75.

Main Results

HA-PCI showed no significant impact on longitudinal SRCF (β = 1.41, p = 0.52) or cognitive impairment (OR 0.81, p = 0.34).
No significant difference in BM incidence between HA-PCI and PCI arms (sHR = 1.03, p = 0.91).
BM occurrence within the HA area was similar between groups (p = 1.0).

Conclusions

HA-PCI did not preserve longitudinal SRCF in SCLC patients.
The risk of developing brain metastases was not increased with HA-PCI.
Further research is needed to enhance the therapeutic ratio of PCI through alternative strategies.

Keywords:

Brain metastases (BM) Hippocampal avoidance-prophylactic cranial irradiation (HA-PCI) Self-reported cognitive functioning (SRCF) Small cell lung cancer (SCLC)

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