Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France.
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Lancet Oncol. 2016 Jul;17(7):e277-e293. doi: 10.1016/S1470-2045(16)30065-1.
The incidence of brain metastases in patients with lung cancer has increased as a result of improved local and systemic control and better diagnosis from advances in brain imaging. Because brain metastases are responsible for life-threatening symptoms and serious impairment of quality of life, resulting in shortened survival, prophylactic cranial irradiation has been proposed in both small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) to try to improve incidence of brain metastasis, survival, and eventually quality of life. Findings from randomised controlled trials and a meta-analysis have shown that prophylactic cranial irradiation not only reduces the incidence of brain metastases in patients with SCLC and with non-metastatic NSCLC, but also improves overall survival in patients with SCLC who respond to first-line treatment. Although prophylactic cranial irradiation is potentially associated with neurocognitive decline, this risk needs to be balanced against the potential benefit in terms of brain metastases incidence and survival. Several strategies to reduce neurotoxicity are being investigated.
由于局部和全身控制的改善以及脑成像技术的进步提高了诊断水平，肺癌患者脑转移的发生率有所增加。由于脑转移是导致危及生命的症状和严重生活质量下降的原因，导致生存时间缩短，因此预防性颅照射已被提议用于小细胞肺癌（SCLC）和非小细胞肺癌（NSCLC），试图改善脑转移的发生率、生存时间，最终改善生活质量。随机对照试验和荟萃分析的结果表明，预防性颅照射不仅降低了对一线治疗有反应的 SCLC 患者和无转移 NSCLC 患者脑转移的发生率，而且提高了 SCLC 患者的总生存率。虽然预防性颅照射可能与神经认知功能下降有关，但需要在脑转移发生率和生存方面的潜在益处与风险之间进行权衡。目前正在研究几种降低神经毒性的策略。
