Figlin R A, Piantadosi S, Feld R
Department of Medicine, School of Medicine, University of California, Los Angeles.
N Engl J Med. 1988 May 19;318(20):1300-5. doi: 10.1056/NEJM198805193182004.
We retrospectively analyzed the risk of intracranial recurrence of cancer in 1532 patients who were surgically treated between 1977 and 1986 for Stage I, II, or III non-small-cell lung cancer, after rigorous surgical and pathological staging. This analysis was undertaken as a background for a possible randomized clinical trial of prophylactic cranial irradiation in such patients. One hundred four patients (6.8 percent) had documented first recurrences involving the brain, including 98 patients (6.4 percent) in whom the brain was the sole site of first recurrence. Sixty patients (3.9 percent) had only intracranial involvement at the time of death. Prognostic variables that had a significant effect on the time to recurrence in the brain were histologic features of the carcinoma (patients with nonsquamous-cell cancers were more at risk than those with squamous-cell cancer), the T1N1/T2N0 and T2N1 staging subsets (T1, tumor less than or equal to 3 cm in diameter; T2, tumor greater than 3 cm; N0, no regional lymph-node metastasis; N1, ipsilateral hilar-lymph-node metastasis), and initial weight loss of more than 10 percent. We conclude that prophylactic cranial irradiation would at best benefit only a very small subset of these patients. We believe, therefore, that neither prophylactic cranial irradiation nor a randomized trial is indicated in patients with non-small-cell lung cancer who have undergone complete resection.
我们回顾性分析了1977年至1986年间接受手术治疗的1532例I、II或III期非小细胞肺癌患者在经过严格的手术和病理分期后的颅内癌症复发风险。该分析作为对此类患者进行预防性颅脑照射的一项可能的随机临床试验的背景。104例患者（6.8%）有记录显示首次复发累及脑部，其中98例患者（6.4%）脑部是首次复发的唯一部位。60例患者（3.9%）在死亡时仅有颅内受累。对脑部复发时间有显著影响的预后变量包括癌的组织学特征（非鳞状细胞癌患者比鳞状细胞癌患者风险更高）、T1N1/T2N0和T2N1分期亚组（T1，肿瘤直径小于或等于3 cm；T2，肿瘤直径大于3 cm；N0，无区域淋巴结转移；N1，同侧肺门淋巴结转移）以及初始体重减轻超过10%。我们得出结论，预防性颅脑照射充其量仅对这些患者中的极小一部分有益。因此，我们认为对于已经接受完全切除的非小细胞肺癌患者，既不建议进行预防性颅脑照射，也不建议进行随机试验。
