Bloom Brooke C, Augustyn Alexander, Sepesi Boris, Patel Sunil, Shah Shalin J, Komaki Ritsuko U, Schild Steven E, Chun Stephen G
Trinity University, San Antonio, TX, United States.
Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Front Oncol. 2017 Sep 29;7:228. doi: 10.3389/fonc.2017.00228. eCollection 2017.
With increasing use of low-dose screening CT scans, the diagnosis of early-stage small-cell lung cancer (SCLC) without evidence of mediastinal nodal or distant metastasis is likely to become more common, but the role of adjuvant therapies such as prophylactic cranial irradiation (PCI) are not well understood in this population. We performed a review of the literature pertaining to the impact of PCI in patients who underwent surgical resection of early-stage SCLC. Four studies were identified that were pertinent including three single-institution retrospective analyses and a National Cancer Database analysis. Based upon these studies, we estimate the rate of brain metastases to be 10-15% for Stage I and 15-25% for Stage II disease without PCI. However, the impact of PCI on the development of brain metastases and its ultimate impact on overall survival were not consistent across these studies. In summary, there is sparse evidence to guide recommendations for PCI following resection of early-stage SCLC. While it may be reasonable to offer PCI to maximize likelihood of cure, alternative strategies such as observation with close imaging follow-up can also be considered for the appropriate patient given the known neurocognitive side effects of PCI.
随着低剂量筛查CT扫描的使用日益增加，无纵隔淋巴结或远处转移证据的早期小细胞肺癌（SCLC）的诊断可能会变得更加常见，但辅助治疗如预防性颅脑照射（PCI）在这一人群中的作用尚未得到充分了解。我们对有关PCI对接受早期SCLC手术切除患者影响的文献进行了综述。确定了四项相关研究，包括三项单机构回顾性分析和一项国家癌症数据库分析。基于这些研究，我们估计在未接受PCI的情况下，I期疾病脑转移率为10%-15%，II期疾病为15%-25%。然而，这些研究中PCI对脑转移发生的影响及其对总生存的最终影响并不一致。总之，对于早期SCLC切除术后PCI的推荐，证据稀少。虽然提供PCI以最大化治愈可能性可能是合理的，但鉴于PCI已知的神经认知副作用，对于合适的患者，也可考虑如密切影像学随访观察等替代策略。
