Laukkanen E, Klonoff H, Allan B, Graeb D, Murray N
Division of Radiation Oncology, Cancer Control Agency of B.C., Victoria Clinic, Canada.
Int J Radiat Oncol Biol Phys. 1988 Jun;14(6):1109-17. doi: 10.1016/0360-3016(88)90386-0.
Ninety-four patients with limited stage small cell lung cancer treated between 1981 and 1985 with a regimen including prophylactic brain irradiation (PBI) after combination chemotherapy were assessed for compliance with PBI, brain relapse, and neurologic morbidity. Seventy-seven percent of patients had PBI and of these, 22% developed brain metastases after a median time of 11 months post treatment. The brain was the apparent unique initial site of relapse in 10% of PBI cases but more commonly brain relapse was preceded or accompanied by failure at other sites, especially the chest. Brain metastases were the greatest cause of morbidity in 50% of PBI failures. Twelve of 14 PBI patients alive 2 years after treatment had oncologic, neurologic, and neuropsychological evaluation, and brain CT. All long-term survivors were capable of self care and none fulfilled diagnostic criteria for dementia, with three borderline cases. One third had pretreatment neurologic dysfunction and two thirds post treatment neurologic symptoms, most commonly recent memory loss. Fifty percent had subtle motor findings. Intellectual functioning was at the 38th percentile with most patients having an unskilled occupational history. Neuropsychologic impairment ratings were borderline in three cases and definitely impaired in seven cases. CT scans showed brain atrophy in all cases with mild progression in those having a pre-treatment baseline. Periventricular and subcortical low density lesions identical to the CT appearance of subcortical arteriosclerotic encephalopathy were seen in 82% of posttreatment CT studies, and lacunar infarcts in 54%. Neuropsychologic impairment scores and the extent of CT periventricular low density lesions were strongly associated (rank correlation 0.7, p less than .05). Overall, PBI after intensive combination chemotherapy did not induce gross dementia or neurologic dysfunction but its risk/benefit ratio is not overwhelmingly favorable, with failure to prevent brain relapse in 1/5 patients and subtle but detectable motor findings and neuropsychologic impairment in the majority.
对1981年至1985年间接受治疗的94例局限期小细胞肺癌患者进行了评估，这些患者在联合化疗后接受了包括预防性脑照射（PBI）的治疗方案，评估内容包括PBI的依从性、脑转移复发以及神经疾病发生率。77%的患者接受了PBI，其中22%在治疗后中位时间11个月出现脑转移。在10%的PBI病例中，脑是明显的唯一初始复发部位，但更常见的是脑转移复发之前或同时伴有其他部位的失败，尤其是胸部。脑转移是50%的PBI治疗失败患者发病的最大原因。14例接受PBI治疗后存活2年的患者中有12例接受了肿瘤学、神经学和神经心理学评估以及脑部CT检查。所有长期存活者都能够自我照顾，没有一例符合痴呆诊断标准，有3例处于临界状态。三分之一的患者治疗前有神经功能障碍，三分之二的患者治疗后有神经症状，最常见的是近期记忆力丧失。50%的患者有轻微运动体征。智力功能处于第38百分位，大多数患者有非熟练职业史。神经心理学损害评级3例处于临界状态，7例明显受损。CT扫描显示所有病例均有脑萎缩，治疗前有基线的患者脑萎缩有轻度进展。82%的治疗后CT研究中可见与皮质下动脉硬化性脑病CT表现相同的脑室周围和皮质下低密度病变，54%的患者有腔隙性梗死。神经心理学损害评分与CT脑室周围低密度病变程度密切相关（等级相关系数0.7，p<0.05）。总体而言，强化联合化疗后的PBI不会导致严重痴呆或神经功能障碍，但其风险/效益比并非绝对有利，五分之一的患者未能预防脑转移复发，大多数患者有轻微但可检测到的运动体征和神经心理学损害。
