Li Hongwei, Xue Ruiqi, Yang Xiaotang, Han Songye, Yang Weihua, Song Xin, Zhang Xiaqin, Cao Jianzhong, Jia Sufang, Wang Weili, Lian Jianhong
Department of Radiotherapy, Shanxi Medical University, Shanxi Cancer Hospital, Taiyuan, China.
Department of Radiology, Shanxi Cancer Hospital, Taiyuan, China.
Front Oncol. 2021 Mar 1;11:568568. doi: 10.3389/fonc.2021.568568. eCollection 2021.
WBRT and systemic chemotherapy are the mainstay treatments for small-cell lung cancer (SCLC) brain metastases (BM). However, current recommendations are mainly based on evidence from retrospective analyses. A recent randomized trial found no benefits from WBRT compared with best supportive care (BSC) in patients with more than three BM from non-small-cell lung cancer (NSCLC). Herein, we aimed to evaluate the roles of WBRT and chemotherapy further in the management of BM from SCLC.
There were 698 patients with BM from SCLC included. Of these, 580 received anti cancer treatment (Group 1), including 178 who received WBRT only (Group 1a), 129 who received chemotherapy only (Group 1b), and 273 who received WBRT plus chemotherapy (Group 1c). The other 118 received BSC (Group 2). Propensity score matching (PSM) analysis was used to compare Group 2 with each of the other groups.
After PSM, compared with Group 2 (n = 118), patients in Group 1 (n = 440) had a prolonged overall survival (OS) in both univariate and multivariate tests, with a median survival time of 10 months (95% CI = 9-11) in Group 1 and 3.5 months (95% CI = 2-7) in Group 2 (p < 0.001). In subgroup analyses, patients who received WBRT plus chemotherapy were more likely to benefit from treatment (p < 0.001). Chemotherapy alone or WBRT alone did not show survival benefits.
WBRT plus chemotherapy improved OS in patients with BM from SCLC as compared to BSC. Chemotherapy alone and WBRT alone did not show survival benefits. This retrospective study suggests that SCLC patients with BM who receive WBRT combined with chemotherapy have a better outcome than those receiving BSC alone.
全脑放疗（WBRT）和全身化疗是小细胞肺癌（SCLC）脑转移（BM）的主要治疗方法。然而，目前的推荐主要基于回顾性分析的证据。一项近期的随机试验发现，对于非小细胞肺癌（NSCLC）脑转移超过三处的患者，与最佳支持治疗（BSC）相比，WBRT并无益处。在此，我们旨在进一步评估WBRT和化疗在SCLC脑转移治疗中的作用。
纳入698例SCLC脑转移患者。其中，580例接受了抗癌治疗（第1组），包括178例仅接受WBRT的患者（第1a组）、129例仅接受化疗的患者（第1b组）以及273例接受WBRT加化疗的患者（第1c组）。另外118例接受BSC（第2组）。采用倾向评分匹配（PSM）分析将第2组与其他各组进行比较。
PSM后，与第2组（n = 118）相比，第1组（n = 440）患者在单因素和多因素检验中总生存期（OS）均延长，第1组的中位生存时间为10个月（95%CI = 9 - 11），第2组为3.5个月（95%CI = 2 - 7）（p < 0.001）。在亚组分析中，接受WBRT加化疗的患者更有可能从治疗中获益（p < 0.001）。单纯化疗或单纯WBRT未显示出生存获益。
与BSC相比，WBRT加化疗可改善SCLC脑转移患者的OS。单纯化疗和单纯WBRT未显示出生存获益。这项回顾性研究表明，接受WBRT联合化疗的SCLC脑转移患者比仅接受BSC的患者预后更好。
