Kotecha Rupesh, Zimmerman Amy, Murphy Erin S, Ahmed Zain, Ahluwalia Manmeet S, Suh John H, Reddy Chandana A, Angelov Lilyana, Vogelbaum Michael A, Barnett Gene H, Chao Samuel T
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.
Technol Cancer Res Treat. 2016 Aug;15(4):566-72. doi: 10.1177/1533034615589033. Epub 2015 Jun 3.
The patterns of intracranial failure in patients with brain metastasis from pulmonary neuroendocrine carcinoma (PNEC) remain unknown.
From 1998 to 2013, 29 patients with the diagnosis of PNEC were treated for brain metastasis: 16 patients (55%) underwent whole-brain radiation therapy (WBRT), 5 (17%) patients underwent WBRT with a stereotactic radiosurgery (SRS) boost, and 8 (28%) patients underwent primary SRS alone.
The median age at treatment was 61 years (range: 44-84 years) and the median follow-up was 9.6 months (0-157.4 months). Of the patients treated with SRS alone, 1 patient had radiographic local progression of disease and 1 patient had a distant intracranial failure. Of the patients treated with WBRT with or without an SRS boost, 9 patients developed intracranial progression, including 1 local failure. No differences in rates of intracranial progression or local failure between the 2 groups (P = .94 and P = .44, respectively) were observed. The actuarial rates of distant intracranial failure at 12 months were 32.9% (95% confidence interval [95% CI] 8.9%-56.8%) and 25% (95% CI 0.0%-67.4%) in patients undergoing primary WBRT or SRS, respectively (P = .31). The median overall survival was 15.8 months in patients treated with WBRT and 20.4 months in patients treated with primary SRS (P = .78).
Patients with brain metastasis from PNECs can be effectively treated with either WBRT or SRS alone, with a pattern of failure more consistent with non-small cell lung cancer than small cell lung cancer. In this series, there was not a statistically significant increased risk of distant intracranial failure when patients were treated with primary SRS.
肺神经内分泌癌（PNEC）脑转移患者的颅内衰竭模式尚不清楚。
1998年至2013年，29例诊断为PNEC的患者接受了脑转移治疗：16例（55%）患者接受了全脑放疗（WBRT），5例（17%）患者接受了全脑放疗联合立体定向放射外科（SRS）强化治疗，8例（28%）患者仅接受了单纯的原发性SRS治疗。
治疗时的中位年龄为61岁（范围：44 - 84岁），中位随访时间为9.6个月（0 - 157.4个月）。仅接受SRS治疗的患者中，1例出现影像学上的疾病局部进展，1例出现颅内远处衰竭。接受WBRT联合或不联合SRS强化治疗的患者中，9例出现颅内进展，其中1例为局部衰竭。两组之间颅内进展率或局部衰竭率无差异（分别为P = 0.94和P = 0.44）。接受原发性WBRT或SRS治疗的患者在12个月时颅内远处衰竭的精算率分别为32.9%（95%置信区间[95%CI] 8.9% - 56.8%）和25%（95%CI 0.0% - 67.4%）（P = 0.31）。接受WBRT治疗的患者中位总生存期为15.8个月，接受原发性SRS治疗的患者中位总生存期为20.4个月（P = 0.78）。
PNEC脑转移患者单独使用WBRT或SRS均可有效治疗，其衰竭模式与非小细胞肺癌比小细胞肺癌更一致。在本系列研究中，接受原发性SRS治疗的患者颅内远处衰竭风险无统计学意义上的增加。
