Tomassen Mathijs L, Aarts Mieke J, Peters Max, van Lindert Anne, De Ruysscher Dirk K M, Verhoeff Joost J C, van Rossum Peter S N
Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
Clin Transl Radiat Oncol. 2021 Feb 12;27:157-163. doi: 10.1016/j.ctro.2021.02.001. eCollection 2021 Mar.
Controversy has arisen regarding the benefit of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC), particularly since the 2017 Takahashi trial publication that supports MRI surveillance in extensive-stage (ES-)SCLC. The primary aim of this study was to assess trends and determinants in PCI use over the years 2010-2018. A secondary aim was to determine contemporary practice considerations among radiation oncologists (ROs).
A nationwide population-based cohort study was conducted using the Netherlands Cancer Registry data on all newly diagnosed SCLC patients (2010-2018). The change in PCI frequency over the years and determinants for PCI were analyzed using logistic regression models. Second, an online survey was performed among Dutch lung cancer ROs in 2020.
Among 10,264 eligible patients, 4,894 (47%) received PCI. Compared to 2010-2014, PCI use significantly decreased in 2017-2018 in ES-SCLC (OR 0.68, 95%CI 0.60-0.77) and LS-SCLC (OR 0.56, 95%CI 0.47-0.67). Incidence year, age, performance status, and thoracic radiotherapy were independent determinants for PCI. Among 41 survey participants, PCI was recommended always/sometimes/never by 22%/71%/7% in ES-SCLC and 54%/44%/2% in LS-SCLC. For ES-SCLC and LS-SCLC, 63% and 25% of ROs, respectively, confirmed influence of the Takahashi trial on PCI recommendations. Denial of such influence was associated with insufficient institutional MRI capacity.
A significant declining trend of PCI use in both ES-SCLC and LS-SCLC was observed in The Netherlands since 2017. The Takahashi trial seems an explanation for this trend even in LS-SCLC, with differential influence of the trial depending on institutional MRI capacity. An alarming increase in practice variation regarding PCI was found which stresses the importance of ongoing trials.
关于小细胞肺癌（SCLC）患者预防性颅脑照射（PCI）的益处一直存在争议，特别是自2017年高桥试验发表以来，该试验支持对广泛期（ES-）SCLC患者进行MRI监测。本研究的主要目的是评估2010 - 2018年期间PCI使用的趋势和决定因素。次要目的是确定放射肿瘤学家（ROs）当前的实践考虑因素。
利用荷兰癌症登记处关于所有新诊断的SCLC患者（2010 - 2018年）的数据进行了一项全国性基于人群的队列研究。使用逻辑回归模型分析多年来PCI频率的变化以及PCI的决定因素。其次，在2020年对荷兰肺癌ROs进行了一项在线调查。
在10264名符合条件的患者中，4894名（47%）接受了PCI。与2010 - 2014年相比，2017 - 2018年ES-SCLC（比值比0.68，95%置信区间0.60 - 0.77）和局限期（LS-）SCLC（比值比0.56，95%置信区间0.47 - 0.67）中PCI的使用显著减少。发病年份、年龄、体能状态和胸部放疗是PCI的独立决定因素。在41名调查参与者中，ES-SCLC中22%/71%/7%的人总是/有时/从不推荐PCI，LS-SCLC中这一比例分别为54%/44%/2%。对于ES-SCLC和LS-SCLC，分别有63%和25%的ROs确认高桥试验对PCI推荐有影响。否认这种影响与机构MRI能力不足有关。
自2017年以来，在荷兰观察到ES-SCLC和LS-SCLC中PCI使用均有显著下降趋势。高桥试验似乎是这一趋势的一个解释，即使在LS-SCLC中也是如此，该试验的影响因机构MRI能力而异。发现PCI的实践差异出现惊人增加，这突出了正在进行的试验的重要性。
