Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Department of Management, University of Akron, Akron, OH 44325, USA.
Future Oncol. 2021 Jul;17(21):2713-2724. doi: 10.2217/fon-2020-1095. Epub 2021 May 7.
The role of prophylactic cranial irradiation (PCI) and thoracic radiation therapy (TRT) in extensive-stage small cell lung cancer remains controversial. The authors examined the National Cancer Database and identified patients with extensive-stage small cell lung cancer with no brain metastasis. Patients were excluded if they died 30 days from diagnosis, did not receive polychemotherapy, had other palliative radiation or had missing information. A propensity score-matched analysis was also performed. A total of 21,019 patients were identified. The majority of patients did not receive radiation (69%), whereas 10% received PCI and 21% received TRT. The addition of PCI and TRT improved median survival and survival at 1 and 2 years (p ≤ 0.05). The propensity score-matched analysis confirmed the same overall survival benefit with both PCI and TRT. This registry-based analysis of >1500 accredited cancer programs shows that PCI and TRT are not commonly utilized for extensive-stage small cell lung cancer patients who are treated with multiagent chemotherapy. The addition of PCI and TRT significantly improves overall survival in this otherwise poor prognostic group. Further research is needed to confirm the role of PCI and TRT, especially in the era of improved systemic therapy.
预防性颅照射（PCI）和胸部放疗（TRT）在广泛期小细胞肺癌中的作用仍存在争议。作者检查了国家癌症数据库，并确定了无脑转移的广泛期小细胞肺癌患者。如果患者在诊断后 30 天内死亡、未接受多化疗、接受其他姑息性放疗或信息缺失，则将其排除在外。还进行了倾向评分匹配分析。共确定了 21019 例患者。大多数患者未接受放疗（69%），而 10%接受了 PCI，21%接受了 TRT。PCI 和 TRT 的加入改善了中位生存期和 1 年及 2 年的生存率（p≤0.05）。倾向评分匹配分析证实了 PCI 和 TRT 具有相同的总体生存获益。这项基于登记的对 1500 多个认可的癌症项目的分析表明，在接受多药物化疗的广泛期小细胞肺癌患者中，PCI 和 TRT 并不常用。PCI 和 TRT 的加入显著改善了这一预后较差患者群体的总体生存率。需要进一步研究来证实 PCI 和 TRT 的作用，特别是在系统治疗改善的时代。
