预防性颅脑照射或全脑放疗后颅内复发生存不良时，是否应考虑立体定向放射外科治疗？基于人群的分析和文献复习。

Should Stereotactic Radiosurgery Be Considered for Salvage of Intracranial Recurrence after Prophylactic Cranial Irradiation or Whole Brain Radiotherapy in Small Cell Lung Cancer? A Population-Based Analysis and Literature Review.

机构信息

Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.

出版信息

J Med Imaging Radiat Sci. 2020 Mar;51(1):75-87.e2. doi: 10.1016/j.jmir.2019.10.001. Epub 2019 Nov 20.

DOI:10.1016/j.jmir.2019.10.001

PMID:31759940

Abstract

BACKGROUND

Prophylactic cranial irradiation (PCI) improves survival and prevents intracranial recurrence (IR) in limited stage (LS) and extensive stage (ES) small cell lung cancer (SCLC). However, despite PCI, IR affects 12%-45%, and limited data exist regarding salvage brain reirradiation (ReRT). We performed a population-based review of IR in SCLC.

METHODS

Demographic, treatment, and outcome data of consecutive patients (N = 371) with SCLC assessed at a tertiary cancer centre (01/2013-12/2015) were abstracted, and summary statistics calculated. Kaplan-Meier estimates and univariate and multivariate analysis (MVA) via the Cox proportional hazard model were performed.

RESULTS

Median age was 66.1 years, and 59.8% were Eastern Cooperative Oncology Group (ECOG) performance status 0-2. Median survival was 24 months (95% CI 18.3-29.7 months) for LS (N = 103) and 7 months (95% CI 6.1-7.9 months) for ES (N = 268). 72 of 103 patients with LS and 97 of 214 of those with ES received PCI. 54 of 268 ES presented with brain metastases (BM) of whom 46 of 54 received whole brain RT (WBRT). 18.9% (32/169) recurred post-PCI (13 LS; 19 ES) and 30.4% (14/46) recurred after WBRT. Of those who recurred/progressed after cranial RT, 56.5% (26/46) had <5 BM, 39.1% had no extracranial disease, and 50% were ECOG 0-2. In retrospect, 17 of 46 would have been candidates for salvage stereotactic radiosurgery: 13 post-PCI and 4 post-WBRT.

CONCLUSIONS

This cohort challenges commonly held beliefs that IR is always diffuse, associated with clinical deterioration, and synchronous with systemic failure. Approximately 1 in 3 SCLC patients with IR after PCI or WBRT appear clinically appropriate for salvage stereotactic radiosurgery.

摘要

背景

预防性颅照射（PCI）可提高局限期（LS）和广泛期（ES）小细胞肺癌（SCLC）患者的生存率并预防颅内复发（IR）。然而，尽管进行了 PCI，仍有 12%-45%的患者发生 IR，并且对于挽救性脑再放疗（ReRT），相关数据有限。我们对 SCLC 的 IR 进行了基于人群的回顾性研究。

方法

从一家三级癌症中心（2013 年 1 月至 2015 年 12 月）评估的连续 SCLC 患者（N=371）的人口统计学、治疗和结局数据中提取摘要统计信息，并进行 Kaplan-Meier 估计和单变量及多变量分析（MVA）。通过 Cox 比例风险模型进行分析。

结果

中位年龄为 66.1 岁，59.8%的患者为东部肿瘤协作组（ECOG）体力状况 0-2 分。LS（N=103）的中位生存期为 24 个月（95%CI 18.3-29.7 个月），ES（N=268）的中位生存期为 7 个月（95%CI 6.1-7.9 个月）。103 例 LS 患者中有 72 例和 214 例 ES 患者中有 97 例接受了 PCI。268 例 ES 中有 54 例出现脑转移（BM），其中 46 例接受了全脑放疗（WBRT）。18.9%（32/169）在 PCI 后复发（13 例 LS；19 例 ES），30.4%（14/46）在 WBRT 后复发。在接受颅放疗后复发/进展的患者中，56.5%（26/46）有<5 个脑转移灶，39.1%无颅外疾病，50%为 ECOG 0-2 分。回顾性分析显示，46 例中有 17 例适合进行挽救性立体定向放疗：13 例为 PCI 后复发，4 例为 WBRT 后复发。