Nesbit Eric G, Leal Ticiana A, Kruser Tim J
Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
Transl Lung Cancer Res. 2019 Sep;8(Suppl 2):S153-S162. doi: 10.21037/tlcr.2019.05.01.
Small cell lung cancer has been a difficult disease to treat with poor survival and few significant improvements in outcomes in the last three decades. Most recently the addition of atezolizumab to chemotherapy in the first-line treatment of extensive-stage small cell lung cancer (ES-SCLC) resulted in improved overall survival and progression-free survival compared to chemotherapy alone. Recent randomized studies examining both consolidative thoracic radiotherapy and prophylactic cranial irradiation (PCI) in ES-SCLC have impacted the utilization of these interventions. The approval of immune checkpoint inhibitors (ICIs) to platinum/etoposide chemotherapy for the treatment of ES-SCLC in the front-line setting may also further impact the role of radiotherapy in this disease. In this article, we review the current evidence supporting thoracic radiotherapy in ES-SCLC and discuss the promising therapeutic implications of thoracic radiation in light of the inclusion of ICIs. We also address how the increasing routine use of surveillance brain magnetic resonance imaging (MRI) and ICIs may diminish the use of PCI in ES-SCLC.
小细胞肺癌一直是一种难以治疗的疾病，生存率低，在过去三十年中治疗效果鲜有显著改善。最近，在广泛期小细胞肺癌（ES-SCLC）的一线治疗中，将阿替利珠单抗添加到化疗方案中，与单纯化疗相比，总生存期和无进展生存期均有所改善。最近针对ES-SCLC的巩固性胸部放疗和预防性脑照射（PCI）的随机研究影响了这些干预措施的应用。免疫检查点抑制剂（ICI）被批准用于一线铂类/依托泊苷化疗治疗ES-SCLC，这也可能进一步影响放疗在该疾病中的作用。在本文中，我们回顾了支持ES-SCLC胸部放疗的现有证据，并根据ICI的纳入情况讨论胸部放疗的潜在治疗意义。我们还探讨了监测脑磁共振成像（MRI）和ICI的常规使用增加如何可能减少ES-SCLC中PCI的使用。
