Department of Medical Oncology, Waterford Regional Hospital, Waterford, Ireland.
J Thorac Oncol. 2013 Sep;8(9):1215-21. doi: 10.1097/JTO.0b013e31829f6b03.
Extrapulmonary small-cell carcinoma (EPSCC) is a rare disease. Management is based on small-cell lung carcinoma. Prophylactic cranial irradiation (PCI) is not routinely administered in EPSCC. This study investigates the role of PCI in EPSCC, by analyzing the incidence, treatment, and survival of patients with brain metastases in a national cohort. Disease biology and epidemiology are also investigated.
Patients diagnosed with primary EPSCC from the National Cancer Registry of Ireland from 1995 to 2007 were identified. The number of patients who developed brain metastases, their survival, and treatment data were documented. Patients who received PCI were investigated. Patient and disease characteristics, treatment, and survival data were stratified by stage and primary site.
Two hundred eighty patients were identified; 141 (50.4%) were men and 139 (49.6%) were women. One hundred eighty six patients (66.4%) had extensive-stage disease, 65 (23.2%) had limited-stage disease, and in 29 patients (10.3%) the stage was unknown. Eighteen patients (6.4%) developed brain metastases, with a median overall survival of 10.1 months. Eleven (61%) received cranial irradiation, and 12 (67%) received palliative chemotherapy. Two patients in the entire cohort (0.17%) received PCI. The most common primary sites included the esophagus (n = 43; 15.4%), cervix uteri (n = 17; 6.0%), bladder (n = 13; 4.6%), and prostate (n = 10; 3.6%). Median overall survival was 15.2 months (10.2-20.6) for limited-stage disease, 2.3 months (1.7-3.1) for extensive-stage EPSCC, and 3.7 months (1.3-8.3) for disease of unknown stage.
Brain metastases were uncommon in EPSCC compared with small-cell lung carcinoma. PCI is thus probably not warranted in this disease.
肺外小细胞癌（EPSCC）是一种罕见疾病。其治疗方法基于小细胞肺癌。在 EPSCC 中，预防性颅脑照射（PCI）通常不常规应用。本研究通过分析爱尔兰国家癌症登记处从 1995 年至 2007 年期间的原发性 EPSCC 患者的脑转移发生率、治疗方法和生存情况，来研究 PCI 在 EPSCC 中的作用。同时还对疾病生物学和流行病学进行了研究。
从爱尔兰国家癌症登记处确定了 1995 年至 2007 年间诊断为原发性 EPSCC 的患者。记录了发生脑转移的患者数量、其生存情况和治疗数据。研究了接受 PCI 的患者。按照分期和原发部位对患者和疾病特征、治疗和生存数据进行分层。
共确定了 280 例患者；141 例（50.4%）为男性，139 例（49.6%）为女性。186 例（66.4%）患者为广泛期疾病，65 例（23.2%）为局限期疾病，29 例（10.3%）患者疾病分期未知。18 例（6.4%）患者发生脑转移，中位总生存期为 10.1 个月。11 例（61%）接受了颅脑照射，12 例（67%）接受了姑息性化疗。整个队列中只有 2 例（0.17%）患者接受了 PCI。最常见的原发部位包括食管（n=43；15.4%）、子宫颈（n=17；6.0%）、膀胱（n=13；4.6%）和前列腺（n=10；3.6%）。局限期疾病的中位总生存期为 15.2 个月（10.2-20.6），广泛期 EPSCC 为 2.3 个月（1.7-3.1），疾病分期未知者为 3.7 个月（1.3-8.3）。
与小细胞肺癌相比，脑转移在 EPSCC 中并不常见。因此，在这种疾病中可能不需要 PCI。
