Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
Radiat Oncol. 2018 Dec 18;13(1):250. doi: 10.1186/s13014-018-1198-4.
The role of the dose escalation strategy in brain radiotherapy for small cell lung cancer (SCLC) patients with brain metastases (BMs) has not been identified. This study aims to determine whether an additional radiation boost to whole brain radiation therapy (WBRT) has beneficial effects on overall survival (OS) compared with WBRT-alone.
A total of 82 SCLC patients who were found to have BMs treated with WBRT plus a radiation boost (n = 33) or WBRT-alone (n = 49) from January 2008 to December 2015 were retrospectively analyzed. All patients were limited-stage (LS) SCLC at the time of the initial diagnosis, and none of them had extracranial metastases prior to detection of BMs. The primary end point was OS.
The median OS for all of the patients was 9.6 months and the 6-, 12- and 24-months OS rates were 69.1, 42.2 and 12.8%, respectively. At baseline, the proportion of more than 3 BMs was significantly higher in the WBRT group than in the WBRT plus boost group (p = 0.0001). WBRT plus a radiation boost was significantly associated with improved OS in these patients when compared with WBRT-alone (13.4 vs. 8.5 months; p = 0.004). Further, the survival benefit still remained significant in WBRT plus boost group among patients with 1 to 3 BMs (13.4 vs. 9.6 months; p = 0.022).
Compared with WBRT-alone, the use of WBRT plus a radiation boost may prolong survival in SCLC patients with BMs. The dose escalation strategy in brain radiotherapy for selected BMs patients with SCLC should be considered.
在有脑转移（BMs）的小细胞肺癌（SCLC）患者中，脑部放疗的剂量递增策略的作用尚未确定。本研究旨在确定与单独全脑放疗（WBRT）相比，WBRT 加放疗增敏是否对总生存（OS）有有益影响。
回顾性分析了 2008 年 1 月至 2015 年 12 月期间接受 WBRT 加放疗增敏（n=33）或单独 WBRT（n=49）治疗的 82 例 SCLC 患者。所有患者在初始诊断时均为局限期（LS）SCLC，在发现 BMs 之前均无颅外转移。主要终点是 OS。
所有患者的中位 OS 为 9.6 个月，6、12 和 24 个月的 OS 率分别为 69.1%、42.2%和 12.8%。在基线时，WBRT 组的 BMs 数量超过 3 个的比例明显高于 WBRT 加增敏组（p=0.0001）。与单独 WBRT 相比，WBRT 加放疗增敏明显改善了这些患者的 OS（13.4 与 8.5 个月；p=0.004）。此外，在 WBRT 加增敏组中，有 1-3 个 BMs 的患者的生存获益仍然显著（13.4 与 9.6 个月；p=0.022）。
与单独 WBRT 相比，WBRT 加放疗增敏可能延长 SCLC 伴 BMs 患者的生存时间。对于 SCLC 伴 BMs 的特定患者，脑部放疗的剂量递增策略值得考虑。
