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

@article{citeulike:2278144, abstract = {PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. 10.1200/JCO.2006.06.0632}, author = {Lee, Jack J. and Bekele, Nebiyou B. and Zhou, Xian and Cantor, Scott B. and Komaki, Ritsuko and Lee, Jin S.}, citeulike-article-id = {2278144}, citeulike-linkout-0 = {http://dx.doi.org/10.1200/JCO.2006.06.0632}, citeulike-linkout-1 = {http://jco.ascopubs.org/cgi/content/abstract/24/22/3597}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/16877726}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=16877726}, day = {1}, doi = {10.1200/JCO.2006.06.0632}, journal = {J Clin Oncol}, keywords = {sclc}, month = {August}, number = {22}, pages = {3597--3603}, posted-at = {2008-01-22 23:15:30}, priority = {2}, title = {Decision Analysis for Prophylactic Cranial Irradiation for Patients With Small-Cell Lung Cancer}, url = {http://dx.doi.org/10.1200/JCO.2006.06.0632}, volume = {24}, year = {2006} }

TY - JOUR ID - citeulike:2278144 L3 - citeulike-article-id:2278144 N2 - PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. 10.1200/JCO.2006.06.0632 IS - 22 JF - J Clin Oncol EP - 3603 TI - Decision Analysis for Prophylactic Cranial Irradiation for Patients With Small-Cell Lung Cancer VL - 24 SP - 3597 KW - sclc AU - Lee, Jack AU - Bekele, Nebiyou AU - Zhou, Xian AU - Cantor, Scott AU - Komaki, Ritsuko AU - Lee, Jin PY - 2006/08/01/ UR - http://dx.doi.org/10.1200/JCO.2006.06.0632 ER -