Manapov Farkhad, Käsmann Lukas, Roengvoraphoj Olarn, Dantes Maurice, Schmidt-Hegemann Nina-Sophie, Belka Claus, Eze Chukwuka
Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany,
Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany,
Lung Cancer (Auckl). 2018 Aug 16;9:49-55. doi: 10.2147/LCTT.S137577. eCollection 2018.
Over 10% of small-cell lung cancer (SCLC) patients have brain metastases (BM) at initial diagnosis; more than 50% will develop BM within 2 years. BM are detected in up to 80% of all patients at autopsy. After primary treatment, prophylactic cranial irradiation (PCI) has been established as standard of care in SCLC patients responding to initial therapy. Based on level I evidence, PCI significantly decreases the risk of intracranial relapse and shows a modest survival benefit after 3 years. However, the role of PCI in defined patient subgroups such as resected SCLC, elderly and extensive stage patients with access to magnetic resonance imaging surveillance and stereotactic radiotherapy is yet to be fully clarified. Furthermore, strategies to effective prevention of neurocognitive decline after PCI remain unclear. All these factors significantly impact treatment decision making and should be evaluated in prospective settings. New concepts such as hippocampal avoidance and drug neuroprotection prevent chronic neurocognitive effects reducing treatment-related side effects of PCI. The aim of this review is to present a summary and update of the latest evidence for patient selection, efficacy and outcome of PCI.
超过10%的小细胞肺癌（SCLC）患者在初次诊断时即有脑转移（BM）；超过50%的患者将在2年内发生脑转移。尸检发现，所有患者中高达80%存在脑转移。在初始治疗后，预防性颅脑照射（PCI）已成为对初始治疗有反应的SCLC患者的标准治疗方法。基于一级证据，PCI显著降低了颅内复发风险，并在3年后显示出适度的生存获益。然而，PCI在特定患者亚组中的作用，如手术切除的SCLC、老年患者以及可进行磁共振成像监测和立体定向放射治疗的广泛期患者，仍有待充分阐明。此外，有效预防PCI后神经认知功能下降的策略仍不明确。所有这些因素都显著影响治疗决策，应在前瞻性研究中进行评估。海马体回避和药物神经保护等新概念可预防慢性神经认知效应，减少PCI的治疗相关副作用。本综述的目的是总结和更新关于PCI患者选择、疗效和结果的最新证据。
