Prophylactic Cranial Irradiation Versus Observation in Stage IV NSCLC Randomized Controlled Clinical Study
Prophylactic Cranial Irradiation, Cumulative Incidence of Brain Metastases
About this trial
This is an interventional treatment trial for Prophylactic Cranial Irradiation, Cumulative Incidence of Brain Metastases focused on measuring stage IV non-small cell lung cancer, PCI
Eligibility Criteria
Inclusion Criteria: Patients with pathologically or cytologically confirmed NSCLC; patients with clinical stage IV and no brain metastases [AJCC 8th edition]; no previous treatment Age 18 ~ 80 years old, body condition score ECOG 0 ~ 2 or KPS≥70; No contraindications such as radiotherapy, EGFR-TKI, chemotherapy, or immunotherapy; IMRT is required for primary tumor radiotherapy. DT: 60-70Gy Metastases are treated with three-dimensional radiotherapy (IMRT/SRT/SBRT/VMAT, etc.) and large segmentation radiotherapy. The subject must have no major organ dysfunction or laboratory tests that meet the following requirements: Hematological tests such as liver and kidney function were in the normal range of laboratory standards; Cardiac function: electrocardiogram excluded organic arrhythmia; Pulmonary function test: FEV1>50%, mild-moderate lung function limited. Signed informed consent before treatment (radiotherapy, chemotherapy, immunization, targeted drug therapy); The patient had good compliance with the treatment and follow-up received. Exclusion Criteria: Patients with brain metastasis; Stage IV NSCLC patients with malignant pleural effusion, pericardial effusion and other serous effusion; Patients with extensive liver metastasis and intrapulmonary metastasis that have seriously affected liver and lung function; Patients with uncontrolled hypertension, diabetes, unstable angina, history of myocardial infarction, or symptomatic congestive heart failure or uncontrolled arrhythmia within the past 12 months; Have a clinically clear diagnosis of heart valve disease; The disease active phase of bacterial, fungal, or viral infection; Mental disorders; Severe impaired lung function; Pregnant or lactating patients; Patients with a history of active malignancy other than small cell lung cancer prior to enrollment; Non-melanoma skin basal cell carcinoma, in situ cervical cancer, cured early prostate cancer excepted; Patients with an allergy and known or suspected allergy to any investigational drug for which no alternative medicine is available; Patients with poor compliance; Researchers consider it inappropriate to participate in this experiment.
Sites / Locations
- Guizhou Cancer HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
PCI arm
observation arm
72 stage IV NSCLC patients were randomly enrolled in the group. And all required to have a baseline negative MRI scan for central nervous system (CNS) disease. For patients with positive TKI detection, TKI combined with concurrent radiotherapy DT60-70Gy for the primary tumor. Imaging reexamination 2 months after TKI treatment confirmed the efficacy of CR, PR, and SD; meanwhile, reexamination of head MR Examination confirmed no intracranial metastasis, and PCI was performed DT 30Gy/10f. For patients with negative TKI detection, the treatment mode was platinum-based regimen chemotherapy combined with concurrent radiotherapy for DT60-70Gy for the primary tumor. Imaging reexamination after 2 cycles of chemotherapy confirmed the efficacy of CR, PR, and SD, and skull MR Examination confirmed that there was no intracranial metastasis. PCI DT: 30Gy/10f.Systematic imaging examinations in the first month following systemic treatment, every 3 months in 2 years, and every 6 months in 5 years.
72 stage IV NSCLC enrolled in the observation group. And all required to have a baseline negative magnetic resonance imaging (MRI) scan for central nervous system (CNS) disease. For patients with positive TKI detection, TKI combined with concurrent radiotherapy DT60-70Gy for the primary tumor. For patients with negative TKI detection, the treatment mode was platinum-based regimen chemotherapy combined with concurrent radiotherapy for DT60-70Gy for the primary tumor. Imaging reexamination after 2 cycles of chemotherapy confirmed the efficacy of CR, PR, and SD, and skull MR Examination confirmed that there was no intracranial metastasis. then observation. Systematic imaging examinations in the first month following systemic treatment, every 3 months in 2 years, and every 6 months in 5 years.