Koh Minji, Song Si Yeol, Jo Ji Hwan, Park Geumju, Park Jae Won, Kim Su Ssan, Choi Eun Kyung
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Inje University Haeundae Paik Hospital, Busan, Korea.
Radiat Oncol J. 2019 Sep;37(3):156-165. doi: 10.3857/roj.2019.00318. Epub 2019 Sep 30.
Prophylactic cranial irradiation (PCI) is a standard treatment for limited-stage small cell lung cancer (LS-SCLC) showing a response to initial treatment, but many patients do not receive PCI due to comorbidities or refusal. This study aims to define the patient group for whom PCI can be omitted with minimal risk.
Patients with LS-SCLC who underwent radiotherapy with curative aim at our institution between January 2004 and December 2015 were retrospectively reviewed. Patients who did not receive PCI were evaluated for brain metastasis-free survival (BMFS), progression-free survival (PFS), overall survival (OS), and prognostic factors for survival, and treatment outcomes were compared with a patient cohort who received PCI.
A total of 350 patients achieved a response following thoracic radiotherapy, and 190 of these patients did not receive PCI. Stage I-II and a complete response (CR) to initial therapy were good prognostic factors for BMFS and OS on univariate analysis. Patients with both stage I-II and a CR who declined PCI showed comparable 2-year BMFS to those who received PCI (92% vs. 89%). In patients who achieved CR, PCI did not significantly improve OS or PFS.
There should be less concern about omitting PCI in patients with comorbidities if they have stage I-II or a CR, with brain metastasis control being comparable to those patients who receive PCI.
预防性颅脑照射（PCI）是局限期小细胞肺癌（LS-SCLC）初始治疗有反应时的标准治疗方法，但许多患者因合并症或拒绝而未接受PCI。本研究旨在确定可将PCI风险降至最低而省略PCI的患者群体。
回顾性分析2004年1月至2015年12月在我院接受根治性放疗的LS-SCLC患者。对未接受PCI的患者评估无脑转移生存期（BMFS）、无进展生存期（PFS）、总生存期（OS）及生存预后因素，并将治疗结果与接受PCI的患者队列进行比较。
共有350例患者在胸部放疗后有反应，其中190例未接受PCI。单因素分析显示，I-II期和对初始治疗的完全缓解（CR）是BMFS和OS的良好预后因素。I-II期且CR但拒绝PCI的患者2年BMFS与接受PCI的患者相当（92%对89%）。在达到CR的患者中，PCI未显著改善OS或PFS。
对于合并症患者，如果其处于I-II期或达到CR，省略PCI时应减少担忧，其脑转移控制情况与接受PCI的患者相当。
