PCI and Brain MRI Follow-up vs Brain MRI Follow-up Alone in Limited-stage SCLC Patients

Not Applicable

Recruiting

Interventions: Radiation: Prophylactic cranial irradiation
Radiation: Thoracic radiotherapy
Drug: Chemotherapy

Brief Summary: At present, prophylactic cranial irradiation (PCI) is part of standard care for patients with limited-stage small cell lung cancer (SCLC) who have achieved good response after definitive thoracic radiotherapy and chemotherapy. However, the value of PCI is being challenged in the era when MRI examination of brain has been popularized.

The goal of this clinical study is to compare PCI and regular brain MRI follow-up (control arm) and regular brain MRI follow-up alone (study arm) in patients with limited-stage SCLC who have received definitive radiotherapy and chemotherapy and acheived complete remission (CR) of tumor.

The main questions to answer are:

1. Whether the 2-year brain metastasis-free survival rate of the study group is not inferior to that of the control group.

2. The difference of 2-year overall survival rate between the control group and the study group.

3. Whether the patients in the study group have better overall quality of life than those in the control group.

Participants will randomly receive either PCI and regular brain MRI follow-up or regular brain MRI follow-up alone.

Recruitment & Eligibility

Inclusion Criteria

Histologically/cytologically proven diagnosis of SCLC.
Age ≥ 18 years.
Karnofsky performance status ( KPS) ≥80.
The limited-stage is defined as the tumor confined to one side of the chest, including ipsilateral hilar, bilateral mediastinum, and bilateral supraclavicular lymph nodes. (The definition of metastatic lymph nodes is that the short diameter ≥ 1cm or PET-CT shows increased metabolism with SUV≥2.5, or proved by mediastinoscopy/EBUS/TBNA biopsy. The thickness of pleural effusion on chest CT is less than 1cm (unless cytology proves to be malignant pleural effusion). According to 8th AJCC/UICC TNM staging system, it is the I-IIIC without intrapulmonary metastasis.
Patients who have received definitive chest radiotherapy and chemotherapy and achieved complete remission of tumor within 4-6 weeks after the end of radio-chemotherapy (in accordance with the Response Evaluation Criteria in Solid Tumors v.1.1 including enhanced CT scan of chest and abdomen, enhanced brain MRI, bone scan and tumor markers).
Good follow-up compliance;
Fully understand this study, and voluntarily sign the informed consent form.

Exclusion Criteria

Patients with a history of malignant tumors (past or concurrent) within 5 years, excluding papillary thyroid cancer, non-malignant melanoma skin cancer and cervical carcinoma in situ.
Patients who have received radical surgery (excluding biopsy).
Patients with psychiatric history, pregnancy and lactation.
Uncontrolled diabetes, hypertension, severe active infection.
Patients with chronic diseases of central nervous system.
Patients with contraindications of brain MRI examination.
Other situations deemed unsuitable by the doctor in charge.

Arm && Interventions

Group	Intervention	Description
Control arm	Thoracic radiotherapy	Patients who are randomized to control arm are those who have achieved complete remission of tumor after definitive radio-chemotherapy and will receive PCI and regular brain MRI follow-up.
Control arm	Chemotherapy	Patients who are randomized to control arm are those who have achieved complete remission of tumor after definitive radio-chemotherapy and will receive PCI and regular brain MRI follow-up.
Study arm	Chemotherapy	Patients who are randomized to study arm are those who have achieved complete remission of tumor after definitive radio-chemotherapy and will receive regular brain MRI follow-up alone.
Control arm	Prophylactic cranial irradiation	Patients who are randomized to control arm are those who have achieved complete remission of tumor after definitive radio-chemotherapy and will receive PCI and regular brain MRI follow-up.
Study arm	Thoracic radiotherapy	Patients who are randomized to study arm are those who have achieved complete remission of tumor after definitive radio-chemotherapy and will receive regular brain MRI follow-up alone.

Primary Outcome Measures

Name	Time	Method
2-year brain metastasis-free survival estimated with kaplan-Meier method	Up to 2 years	To test with a one-sided significance of 5% whether for the treatment of limited-stage SCLC patients, brain MRI follow-up alone is non-inferior in terms of 2-year brain metastasis-free survival compared to PCI and brain MRI follow-up. Participants were monitored for up to 2 years. The brain metastasis-free survival time is defined as the time between the date of the first treatment until the date of first documented diagnosis of brain metastasis or the date of death from any cause.

Secondary Outcome Measures

Name	Time	Method
2-year overall survival estimated with kaplan-Meier method	Up to 2 years	To compare 2-year overall survival between patients who receive brain MRI follow-up alone and those who receive both PCI and brain MRI follow-up, with kaplan-Meier estimates. Participants were monitored for up to 2 years. The overall survival time is defined as the time between the date of the first treatment until the date of death from any cause.
Intra-cranial progressive patterns	Up to 2 years	To compare the intra-cranial progressive patterns between patients who receive brain MRI follow-up alone and those who receive both PCI and brain MRI follow-up within 2 years. Intra-cranial progression is evaluated via the Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. In this study, Intra-cranial progressive disease is defined as the new lesions developed in the brain.

Locations (2): Sun Yat-sen University, Cancer Center
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Guangzhou, Guangdong, China
Zhejiang Cancer Hospital
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Hangzhou, Zhejiang, China