Department of Radiation Oncology, Hyogo Cancer Center, Akashi City, Hyogo 673-8558, Japan.
J Radiat Res. 2021 Sep 13;62(5):877-883. doi: 10.1093/jrr/rrab053.
We attempted to re-evaluate the efficacy of prophylactic cranial irradiation (PCI) in limited-stage small cell lung cancer (LS-SCLC) with more recent data. A total of 179 patients with LS-SCLC received radical thoracic radiotherapy and chemotherapy at our institution between 1998 and 2018. One hundred twenty-eight patients who achieved complete response (CR), good partial response (PR), and PR without progression for at least for one year after initial therapy were enrolled in this study. These patients were divided into a PCI group (group A, n = 43), and a non-PCI group (group B, n = 85). Survival outcomes were retrospectively evaluated. Because several background factors differed significantly between groups A and B, propensity score (PS) matching was performed as 1:1 match of the two groups. Finally, we analyzed 64 patients (group A/B = 32/32). Median follow-up periods were 53 and 31 months in groups A and B, respectively. There were no significant differences between the groups' backgrounds. Two-year overall survival (OS) rates were 77% in group A and 62% in group B (p = 0.224). Two-year brain metastasis free survival (BMFS) rates were 85% in group A and 57% in group B (p = 0.008). The number of patients who underwent a brain imaging test for confirmation of no brain metastasis (BM) after radical thoracic radiotherapy and chemotherapy (before PCI) was 84 (group A/B = 32/52). A PS matched analysis for cases of pre-PCI brain imaging group, two-year OS rates for group A/B were 73/59% (p = 0.446). Two-year BMFS rates for group A/B were 91/52% (p = 0.021). Retrospectively, PS matched analysis revealed that adding PCI to LS-SCLC patients who achieved good thoracic control significantly improved BMFS, but OS did not improve.
我们试图用最新的数据重新评估预防性颅脑照射（PCI）在局限期小细胞肺癌（LS-SCLC）中的疗效。1998 年至 2018 年期间，我院共有 179 例 LS-SCLC 患者接受根治性胸部放疗和化疗。本研究纳入了 128 例初始治疗后完全缓解（CR）、部分缓解（PR）和 PR 且至少 1 年无进展的患者。这些患者被分为 PCI 组（A 组，n=43）和非 PCI 组（B 组，n=85）。回顾性评估生存结局。由于 A 组和 B 组的几个背景因素差异显著，因此对两组进行了倾向评分（PS）匹配，每组 1:1 匹配。最终，我们分析了 64 例患者（A 组/B 组=32/32）。A 组和 B 组的中位随访时间分别为 53 个月和 31 个月。两组的背景无显著差异。A 组和 B 组的 2 年总生存率（OS）分别为 77%和 62%（p=0.224）。A 组和 B 组的 2 年无脑转移生存（BMFS）率分别为 85%和 57%（p=0.008）。在根治性胸部放疗和化疗后（在 PCI 之前），行脑部影像学检查以确认无脑转移（BM）的患者有 84 例（A 组/B 组=32/52）。对行 PCI 前脑部影像学检查的患者进行 PS 匹配分析，A 组/B 组的 2 年 OS 率分别为 73/59%（p=0.446）。A 组/B 组的 2 年 BMFS 率分别为 91/52%（p=0.021）。回顾性 PS 匹配分析显示，在达到良好胸部控制的 LS-SCLC 患者中加入 PCI 可显著提高 BMFS，但 OS 没有改善。
