Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France.
Curr Opin Oncol. 2010 Mar;22(2):94-101. doi: 10.1097/CCO.0b013e32833500ef.
Brain metastases are frequent in lung cancer. They are responsible for life-threatening symptoms and serious impairment in patients' quality of life, resulting in a shortened survival. Prophylactic cranial irradiation (PCI) has been proposed in both small-cell lung cancers (SCLCs) and non-SCLCs to reduce the incidence of brain metastases and increase survival.
PCI reduces the incidence of brain metastasis in both limited disease and extensive disease SCLC and in nonmetastatic non-SCLC. In addition, PCI significantly improves overall survival in limited disease and extensive disease SCLC in patients who respond to first-line treatment. Although PCI is potentially associated with long-term neurological toxicity, no significant increase in late sequelae has been shown in randomized trials between PCI and no PCI patients. No dose-effect relationship for PCI was demonstrated in limited disease SCLC patients in a well powered randomized trial.
In limited disease SCLCs, PCI should be administered at the dose of 25 Gy in 10 fractions to first-line treatment responders. In extensive disease SCLC, PCI is recommended in patients who respond to first-line chemotherapy. Clinical trials are ongoing to investigate the role of PCI in non-SCLC patients.
脑转移是肺癌的常见并发症。它们会导致危及生命的症状和严重的生活质量下降，从而缩短患者的生存时间。预防性颅脑照射（PCI）已被提议用于小细胞肺癌（SCLC）和非小细胞肺癌（NSCLC），以降低脑转移的发生率并提高生存率。
PCI 可降低局限期和广泛期 SCLC 以及无远处转移的 NSCLC 患者的脑转移发生率。此外，PCI 可显著改善一线治疗应答患者的局限期和广泛期 SCLC 的总生存率。虽然 PCI 可能与长期神经毒性相关，但随机试验并未显示 PCI 与无 PCI 患者之间存在晚期后遗症的显著增加。在一项设计良好的随机试验中，对于局限期 SCLC 患者，并未显示出 PCI 的剂量效应关系。
在局限期 SCLC 中，对于一线治疗应答者，PCI 应给予 25 Gy/10 次的剂量。在广泛期 SCLC 中，PCI 推荐用于对一线化疗有应答的患者。目前正在进行临床试验以研究 PCI 在 NSCLC 患者中的作用。
