非小细胞肺癌患者预防性颅脑照射的耐受性和毒性——一项II期研究的结果（包括血液学毒性、垂体功能及磁共振波谱变化评估）
Tolerability and toxicity of prophylactic cranial irradiation in patients with non-small cell lung cancer - Results of a phase II study (with estimation of hematological toxicity, pituitary function and magnetic resonance spectra changes).
作者信息
Gawkowska-Suwińska Marzena, Blamek Sławomir, Heyda Alicja, Boguszewicz Lukasz, Cichoń Anna, Zarudzki Lukasz, Nowicka Elżbieta, Behrendt Katarzyna, Smolska-Ciszewska Beata, Plewicki Grzegorz, Zajusz Aleksander, Tarnawski Rafał
机构信息
Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
出版信息
Rep Pract Oncol Radiother. 2014 Jul 17;19(6):361-8. doi: 10.1016/j.rpor.2014.05.002. eCollection 2014 Nov.
AIM
To evaluate the tolerability and toxicity of PCI in patients with NSCLC.
BACKGROUND
Prophylactic cranial irradiation (PCI) is a standard treatment for patients with small cell lung cancer. There are data showing a decreasing ratio of brain metastases after PCI for non-small cell lung cancer (NSCLC-non small cell lung cancer) patients but, so far, there is no evidence for increasing overall survival. The main concern in this setting is the tolerance and toxicity of the treatment.
MATERIALS AND METHODS
From 1999 to 2007, 50 patients with NSCLC treated with radical intent underwent PCI (30 Gy in 15 fractions). Mean follow-up was 2.8 years. The tolerability and hematological toxicity were evaluated in all patients, a part of participants had done neuropsychological tests, magnetic resonance imaging with (1)H nuclear magnetic resonance spectra, and estimation of pituitary function.
RESULTS
During follow-up, 20 patients developed distant metastases, 4-brain metastases. Fourteen (30%) patients had acute side effects: (headache, nausea, erythema of the skin). The symptoms did not require treatment breaks. Six patients complained of late side effects (vertigo, nausea, anxiety, lower extremity weakness, deterioration of hearing and olfactory hyperesthesia). Hematological complications were not observed. Testosterone levels tended to decrease (p = 0.062). Visual-motor function deteriorated after treatment (p < 0.059). Performance IQ decreased (p < 0.025) and the difference between performance IQ and verbal IQ increased (p < 0.011). Degenerative periventricular vascular changes were observed in two patients. Analysis of the spectroscopic data showed metabolic but reversible alterations after PCI.
CONCLUSION
PCI in the current series was well tolerated and associated with a relatively low toxicity.
目的
评估非小细胞肺癌（NSCLC）患者接受全脑预防性照射（PCI）的耐受性和毒性。
背景
全脑预防性照射是小细胞肺癌患者的标准治疗方法。有数据显示，非小细胞肺癌（NSCLC）患者接受PCI后脑转移率有所下降，但迄今为止，尚无证据表明总生存期有所延长。这种情况下主要关注的是治疗的耐受性和毒性。
材料与方法
1999年至2007年，50例接受根治性治疗的NSCLC患者接受了PCI（15次分割，共30 Gy）。平均随访时间为2.8年。对所有患者评估耐受性和血液学毒性，部分参与者进行了神经心理学测试、氢质子磁共振波谱的磁共振成像以及垂体功能评估。
结果
随访期间，20例患者发生远处转移，4例发生脑转移。14例（30%）患者出现急性副作用（头痛、恶心、皮肤红斑）。这些症状无需中断治疗。6例患者主诉有晚期副作用（眩晕、恶心、焦虑、下肢无力、听力减退和嗅觉过敏）。未观察到血液学并发症。睾酮水平有下降趋势（p = 0.062）。治疗后视觉运动功能恶化（p < 0.059）。操作智商下降（p < 0.025），操作智商与言语智商之间的差异增大（p < 0.011）。2例患者观察到脑室周围血管退行性改变。光谱数据分析显示PCI后有代谢性但可逆的改变。
结论
本研究系列中的PCI耐受性良好，毒性相对较低。
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