Pöttgen Christoph, Eberhardt Wilfried, Stuschke Martin
Department of Radiotherapy, University of Essen Medical School, Hufelandstrasse 55, 45122 Essen, Germany.
Curr Treat Options Oncol. 2004 Feb;5(1):43-50. doi: 10.1007/s11864-004-0005-7.
Patients with locally advanced lung cancer (non-small cell lung cancer or small cell lung cancer ) are threatened by concurrent risks of local, regional, and distant failure. By improving locoregional and systemic control within multimodality protocols, the brain emerges as one of the major relapse sites; therefore, prevention of brain relapse has become a primary focus of attention. Prophylactic cranial irradiation (PCI) has a high potential to reduce the risk of brain metastases. Clear evidence exists from meta-analysis that PCI improves overall and disease-free survival rates for patients with SCLC in complete remission. Long-term toxicities, predominantly neurocognitive impairments, represent potential risks, but within large prospective trials, including adequate control groups, late complications of clinical significance rarely have been observed. PCI is the recommended standard of care for the patients with limited disease SCLC in complete remission. As long as the optimal dose and fractionation remain to be defined in this setting, conventional fractionation with moderate total doses of approximately 30 Gy is preferred. In patients with locally advanced stage III non-small cell lung cancer treated within multimodality protocols, comparable relative risks for cumulative brain relapse have been demonstrated in long-term survivors. Although not the standard of care in this situation, the scientific community should be encouraged to further investigate PCI in these patient subgroups within carefully designed clinical trials, including untreated control arms.
局部晚期肺癌（非小细胞肺癌或小细胞肺癌）患者面临局部、区域和远处复发的风险。通过在多模式治疗方案中改善局部区域和全身控制，脑成为主要复发部位之一；因此，预防脑复发已成为主要关注焦点。预防性颅脑照射（PCI）具有降低脑转移风险的巨大潜力。荟萃分析有明确证据表明，PCI可提高完全缓解的小细胞肺癌患者的总生存率和无病生存率。长期毒性，主要是神经认知障碍，是潜在风险，但在包括适当对照组的大型前瞻性试验中，很少观察到具有临床意义的晚期并发症。PCI是完全缓解的局限期小细胞肺癌患者推荐的标准治疗方法。由于在此情况下最佳剂量和分割方案仍有待确定，因此首选总剂量约30 Gy的常规分割。在接受多模式治疗方案的局部晚期III期非小细胞肺癌患者中，长期幸存者的累积脑复发相对风险相当。虽然在这种情况下PCI并非标准治疗方法，但应鼓励科学界在精心设计的临床试验中，包括未治疗的对照组，在这些患者亚组中进一步研究PCI。
