Nosaki Kaname, Seto Takashi
Department of Thoracic Oncology, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
Curr Treat Options Oncol. 2015 Dec;16(12):56. doi: 10.1007/s11864-015-0372-2.
The standard therapy for limited disease small cell lung cancer (LD-SCLC) is concurrent chemoradiotherapy and prophylactic cranial irradiation (PCI) for those who achieve complete remission (CR) or good partial response (PR) with initial therapy. On the other hand, the standard therapy for extensive disease (ED-SCLC) is chemotherapy only. After the two phase III study conducted by Slotman et al., PCI with/without thoracic radiotherapy (TRT) is also recommended in the treatment of ED-SCLC. However, a Japanese phase III study failed to confirm the benefit of PCI for patients with ED-SCLC. All studies have demonstrated the effectiveness of PCI for preventing brain metastasis, but PCI seems to have a limited influence on OS. In the 2014 edition of the Guidelines for the Treatment of Lung Cancer from the Japan Lung Cancer Society (JLCS), use of PCI for patients with ED-SCLC has been changed from "recommended" to "not recommended". Appropriate selection of patients for PCI with/without TRT is very important. It is hoped that the characteristics of patients for whom PCI with/without TRT should be considered or avoided will be better defined in the future.
局限期小细胞肺癌（LD-SCLC）的标准治疗方法是同步放化疗，对于初始治疗获得完全缓解（CR）或良好部分缓解（PR）的患者进行预防性颅脑照射（PCI）。另一方面，广泛期（ED-SCLC）的标准治疗方法仅为化疗。在Slotman等人进行的两项III期研究之后，PCI联合或不联合胸部放疗（TRT）也被推荐用于ED-SCLC的治疗。然而，一项日本的III期研究未能证实PCI对ED-SCLC患者的益处。所有研究均已证明PCI在预防脑转移方面的有效性，但PCI对总生存期（OS）的影响似乎有限。在日本肺癌学会（JLCS）2014年版的肺癌治疗指南中，ED-SCLC患者使用PCI已从“推荐”改为“不推荐”。正确选择接受PCI联合或不联合TRT的患者非常重要。希望未来能更好地明确应考虑或避免接受PCI联合或不联合TRT治疗的患者特征。
