Robnett T J, Machtay M, Stevenson J P, Algazy K M, Hahn S M
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
J Clin Oncol. 2001 Mar 1;19(5):1344-9. doi: 10.1200/JCO.2001.19.5.1344.
As therapy for locally advanced non-small-cell lung carcinoma (NSCLC) improves, brain metastases (BM) may become a greater problem. We analyzed our chemoradiation experience for patients at highest risk for the brain as the first failure site.
Records for 150 consecutive patients with stage II/III NSCLC treated definitively with chemoradiation from June 1992 to June 1998 at the University of Pennsylvania were reviewed. Most patients (89%) received cisplatin, paclitaxel, or both. All had negative brain imaging before treatment. Posttreatment brain imaging was performed for suspicious symptoms. Incidence of BM was examined as a function of age, sex, histology, stage, performance status, weight loss, tumor location, surgery, radiation dose, initial radiation field, chemotherapy regimen, and chemotherapy timing.
Crude and 2-year actuarial rates of BM were 19% and 30%, respectively. Among pretreatment parameters, stage IIIB was associated with a higher risk of BM (P <.04) versus stage II/IIIA. Histology alone was not significant (P <.12), although patients with IIIB nonsquamous tumors had an exceptionally high 2-year BM rate of 42% (P <.01 v all others). Examining treatment-related parameters, crude and 2-year actuarial risk of BM were 27% and 39%, respectively, in patients receiving chemotherapy before radiotherapy and 15% and 20%, respectively, when radiotherapy was not delayed (P <.05). On multivariate analysis, timing of chemotherapy (P <.01) and stage IIIA versus IIIB (P <.01) remained significant.
Patients with later stage, nonsquamous NSCLC, particularly those receiving induction chemotherapy, have sufficiently common BM rates to justify future trials including prophylactic cranial irradiation.
随着局部晚期非小细胞肺癌（NSCLC）治疗方法的改进，脑转移（BM）可能会成为一个更严重的问题。我们分析了以脑作为首个失败部位的高危患者的放化疗经验。
回顾了1992年6月至1998年6月在宾夕法尼亚大学接受放化疗的150例连续的II/III期NSCLC患者的记录。大多数患者（89%）接受了顺铂、紫杉醇或两者联合治疗。所有患者在治疗前脑成像均为阴性。出现可疑症状时进行治疗后脑成像。将脑转移的发生率作为年龄、性别、组织学类型、分期、体能状态、体重减轻、肿瘤位置、手术、放射剂量、初始放疗野、化疗方案和化疗时机的函数进行研究。
脑转移的粗发生率和2年精算发生率分别为19%和30%。在预处理参数中，与II/IIIA期相比，IIIB期发生脑转移的风险更高（P<.04）。仅组织学类型无显著意义（P<.12），尽管IIIB期非鳞状肿瘤患者的2年脑转移发生率异常高，为42%（与其他所有患者相比，P<.01）。在研究与治疗相关的参数时，放疗前接受化疗的患者脑转移的粗发生率和2年精算风险分别为27%和39%，而放疗未延迟时分别为15%和20%（P<.05）。多因素分析显示，化疗时机（P<.01）和IIIA期与IIIB期相比（P<.01）仍然具有显著意义。
晚期非鳞状NSCLC患者，尤其是接受诱导化疗的患者，脑转移发生率足够高，足以证明未来开展包括预防性颅脑照射的试验是合理的。
