Slotman Ben J, Faivre-Finn Corinne, van Tinteren Harm, Keijser Astrid, Praag John, Knegjens Joost, Hatton Matthew, van Dam Iris, van der Leest Annija, Reymen Bart, Stigt Jos, Haslett Kate, Tripathi Devashish, Smit Egbert F, Senan Suresh
VU University Medical Center, Amsterdam, Netherlands.
University of Manchester & The Christie NHS Foundation Trust, Manchester, United Kingdom.
Lung Cancer. 2017 Jun;108:150-153. doi: 10.1016/j.lungcan.2017.03.007. Epub 2017 Mar 21.
In ES-SCLC patients with residual intrathoracic disease after first-line chemotherapy, the addition of thoracic radiotherapy reduces the risk of intrathoracic recurrence, and improves 2-year survival. To identify patient subgroups for future trials investigating higher dose (extra)thoracic radiotherapy, we investigated the prognostic importance of number and sites of metastases in patients included in the CREST trial.
MATERIALS/ METHODS: Additional data on sites and numbers of metastases were collected from individual records of 260 patients from the top 9 recruiting centers in the randomized CREST trial (53% of 495 study patients), which compared thoracic radiotherapy (TRT) to no TRT in ES-SCLC patients after any response to chemotherapy. All patients received prophylactic cranial irradiation.
The clinical characteristics and outcomes of the 260 patients analyzed here did not differ significantly from that of the other 235 patients included in the CREST trial, except that fewer patients had a WHO=0 performance status (24% vs 45%), and a higher proportion had WHO=2 (15% vs 5%; p<0.0001). No distant metastases were recorded in 5%, 39% had metastases confined to one organ, 34% to two, and 22% to three or more organ sites. Metastases were present in the liver (47%), bone (40%), lung (28%), extrathoracic (non-supraclavicular) lymph nodes (19%), supraclavicular nodes (18%), adrenals (17%) and other sites (12%). The OS (p=0.02) and PFS (p=0.04) were significantly better in patients with 2 or fewer metastases, with OS significantly worse if liver (p=0.03) and/or bone metastases (p=0.04) were present.
This analysis of patients recruited from the top 9 accruing centers in the CREST trial suggests that future studies evaluating more intensive thoracic and extra-thoracic radiotherapy in ES-SCLC should focus on patients with fewer than 3 distant metastases.
在一线化疗后胸内仍有残留病灶的广泛期小细胞肺癌（ES-SCLC）患者中，加用胸部放疗可降低胸内复发风险，并提高2年生存率。为了确定未来研究更高剂量（胸外）放疗的试验中的患者亚组，我们研究了参与CREST试验的患者转移灶数量和部位的预后重要性。
材料/方法：从随机CREST试验中排名前9的招募中心的260例患者的个体记录中收集转移灶部位和数量的额外数据（占495例研究患者的53%），该试验比较了ES-SCLC患者化疗有任何反应后胸部放疗（TRT）与不放疗的效果。所有患者均接受了预防性脑照射。
这里分析的260例患者的临床特征和结局与CREST试验中纳入的其他235例患者相比无显著差异，只是世界卫生组织（WHO）体能状态评分为0的患者较少（24%对45%），而WHO体能状态评分为2的患者比例较高（15%对5%；p<0.0001）。5%的患者未记录到远处转移，39%的患者转移局限于一个器官，34%局限于两个器官，22%局限于三个或更多器官部位。转移灶出现在肝脏（47%）、骨（40%）、肺（28%）、胸外（非锁骨上）淋巴结（19%）、锁骨上淋巴结（18%）、肾上腺（17%）和其他部位（12%）。转移灶为2个或更少的患者总生存期（OS，p=0.02）和无进展生存期（PFS，p=0.04）显著更好，若存在肝脏转移（p=0.03）和/或骨转移（p=0.04），总生存期显著更差。
对CREST试验中排名前9的招募中心的患者进行的这项分析表明，未来评估ES-SCLC更强化胸部和胸外放疗的研究应聚焦于远处转移少于3个的患者。
