Bernhardt Denise, Bozorgmehr Farastuk, Adeberg Sebastian, Opfermann Nils, von Eiff Damian, Rieber Juliane, Kappes Jutta, Foerster Robert, König Laila, Thomas Michael, Debus Jürgen, Steins Martin, Rieken Stefan
University Hospital Heidelberg, Department of Radiation Oncology, INF 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany.
Lung Cancer. 2016 Nov;101:76-81. doi: 10.1016/j.lungcan.2016.09.010. Epub 2016 Sep 14.
Patients with brain metastases from small-cell lung cancer (SCLC) who underwent prior prophylactic cranial irradiation (PCI) are often treated with a second course of whole brain radiation therapy (Re-WBRT) or stereotactic radiosurgery (SRS) for purposes of palliation in symptomatic patients, hope for increased life expectancy or even as an alternative to untolerated steroids. Up to date there is only limited data available regarding the effect of this treatment. This study examines outcomes in patients in a single institution who underwent cerebral re-irradiation after prior PCI.
We examined the medical records of 76 patients with brain metastases who had initially received PCI between 2008 and 2015 and were subsequently irradiated with a second course of cerebral radiotherapy. Patients underwent re-irradiation using either Re-WBRT (88%) or SRS (17%). The outcomes, including symptom palliation, radiation toxicity, and overall survival (OS) following re-irradiation were analyzed. Survival and correlations were calculated using log-rank, univariate, and multivariate Cox proportional hazards-ratio analyses. Treatment-related toxicity was classified according to CTCAE v4.0.
Median OS of all patients was 3 months (range 0-12 months). Median OS after Re-WBRT was 3 months (range 0-12 months). Median OS after SRS was 5 months (range 0-12 months). Karnofsky performance status scale (KPS ≥50%) was significantly associated with improved OS in both univariate (HR 2772; p=0,009) and multivariate analyses (HR 2613; p=0,024) for patients receiving Re-WBRT. No unexpected toxicity was observed and the observed toxicity remained consistently low. Symptom palliation was achieved in 40% of symptomatic patients.
In conclusion, cerebral re-irradiation after prior PCI is beneficial for symptom palliation and is associated with minimal side effects in patients with SCLC. Our survival data suggests that it is primarily useful in patients with adequate performance status.
既往接受过预防性颅脑照射（PCI）的小细胞肺癌（SCLC）脑转移患者，常因缓解有症状患者的症状、期望延长生存期，甚至作为无法耐受的类固醇药物的替代方案，而接受第二轮全脑放射治疗（再程WBRT）或立体定向放射外科治疗（SRS）。目前关于这种治疗效果的数据有限。本研究考察了在单一机构中既往接受PCI后接受脑部再程照射的患者的预后情况。
我们查阅了76例脑转移患者的病历，这些患者在2008年至2015年间首次接受了PCI，随后接受了第二轮脑部放疗。患者采用再程WBRT（88%）或SRS（17%）进行再程照射。分析了再程照射后的预后情况，包括症状缓解、放射毒性和总生存期（OS）。使用对数秩检验、单因素和多因素Cox比例风险比分析计算生存率和相关性。根据CTCAE v4.0对治疗相关毒性进行分类。
所有患者的中位OS为3个月（范围0 - 12个月）。再程WBRT后的中位OS为3个月（范围0 - 12个月）。SRS后的中位OS为5个月（范围0 - 12个月）。在接受再程WBRT的患者中，卡诺夫斯基功能状态量表（KPS≥50%）在单因素分析（HR 2772；p = 0.009）和多因素分析（HR 2613；p = 0.024）中均与改善的OS显著相关。未观察到意外毒性，且观察到的毒性一直较低。40%的有症状患者实现了症状缓解。
总之，既往PCI后进行脑部再程照射对症状缓解有益，且在SCLC患者中副作用最小。我们的生存数据表明，它主要对功能状态良好的患者有用。
