Department of Respiration, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Thorac Cancer. 2020 May;11(5):1239-1244. doi: 10.1111/1759-7714.13381. Epub 2020 Mar 6.
It has previously been demonstrated that surgically resected small-cell lung cancer (SCLC) patients could benefit from prophylactic cranial irradiation (PCI). However, PCI in patients without lymph node involvement remains controversial. This study includes a larger sample size to evaluate the benefit of PCI therapy in this specific population.
The records of surgically resected SCLC patients without lymph node involvement (N0M0) in Shanghai Chest Hospital were retrospectively reviewed.
Between January 2006 and May 2017, a total of 146 cases of surgically resected SCLC without lymph node involvement were included. A total of 46 patients received PCI therapy and 100 patients received no therapy. During the observation period, 12.0% (12/100) of the patients who did not receive PCI therapy developed brain metastases while 10.9% (5/46) of patients who received PCI therapy developed brain metastases. With regard to time to recurrence, no significant difference was observed among the groups (P = 0.798). Moreover, there was no significant difference in either the overall survival benefit (hazard ratio [HR] = 0.84, 95% confidence interval [CI]: 0.49-1.45, P = 0.532) or disease-free survival rate (HR = 0.95, 95% CI: 0.52-1.75, P = 0.864).
The evidence obtained does not support PCI therapy in the management of surgically resected SCLC with no lymph node involvement.
Prophylactic cranial irradiation (PCI) remains controversial for resected small-cell lung cancer (SCLC) without lymph node involvement. In this study, the results indicated that PCI does not reduce the risk of cerebral recurrence of resected p-T1-2N0M0 SCLC. This is the largest sample size study focused on PCI in resected p-T1-2N0M0 SCLC. Future revised versions of the guidelines should address this issue.
先前已经证实，手术切除的小细胞肺癌（SCLC）患者可从预防性颅脑照射（PCI）中获益。然而，对于无淋巴结受累的患者，PCI 仍存在争议。本研究纳入了更大的样本量，以评估该特定人群中 PCI 治疗的获益。
回顾性分析上海胸科医院手术切除的无淋巴结受累（N0M0）的 SCLC 患者的病历资料。
2006 年 1 月至 2017 年 5 月，共纳入 146 例手术切除的无淋巴结受累的 SCLC 患者。其中，46 例患者接受了 PCI 治疗，100 例患者未接受治疗。在观察期间，未接受 PCI 治疗的患者中有 12.0%（12/100）发生脑转移，而接受 PCI 治疗的患者中有 10.9%（5/46）发生脑转移。两组间复发时间无显著差异（P=0.798）。此外，两组间总生存获益（风险比[HR]=0.84，95%置信区间[CI]：0.49-1.45，P=0.532）或无病生存率（HR=0.95，95%CI：0.52-1.75，P=0.864）均无显著差异。
现有证据不支持对无淋巴结受累的手术切除 SCLC 进行 PCI 治疗。
对于无淋巴结受累的手术切除小细胞肺癌（SCLC），预防性颅脑照射（PCI）仍存在争议。本研究结果表明，PCI 并不能降低切除的 p-T1-2N0M0 SCLC 脑复发的风险。这是针对切除的 p-T1-2N0M0 SCLC 中 PCI 研究中样本量最大的研究。未来指南的修订版应解决这一问题。
