Li Hanming, Li Wang, Qi Chao, Zhou Lu, Wen Fengyun, Qu Yanli, Yu Hong
School of Graduate, Dalian Medical University, Dalian, China.
Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
Front Oncol. 2021 Oct 25;11:726613. doi: 10.3389/fonc.2021.726613. eCollection 2021.
This study aimed to evaluate the survival outcomes of whole brain radiotherapy (WBRT) compared to whole brain radiotherapy plus local radiation boost (WBRT + boost), and further identify whether higher biologically effective dose (BED) of WBRT + boost translates into a survival benefit in small cell lung cancer (SCLC) patients with brain metastasis (BM).
SCLC patients with BM from January 1, 2012, to December 31, 2019, were retrospectively analyzed. Overall survival (OS) and intracranial progression-free survival (iPFS) were evaluated by the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate regression analyses of prognostic factors for OS were performed using Cox proportional hazards regression models. The cutoff value of BED was determined by the receiver operating characteristic (ROC) curve analysis.
Among the 180 eligible patients, 82 received WBRT + boost and 98 received WBRT. Both OS and iPFS in the WBRT + boost group were significantly superior to those in the WBRT group (median OS: 20 . 14 months, = 0.011; median iPFS: 16 . 10 months, = 0.003). At a cutoff value of 58.35 Gy in the WBRT + boost group, 52 for the high-BED (>58.35 Gy) group, 30 for the low-BED (≤58.35 Gy) group. High BED was significantly associated with improved OS and iPFS compared with low BED in the WBRT + boost group (median OS: 23 . 17 months, = 0.002; median iPFS: 17 . 10 months, = 0.002).
Compared with WBRT alone, WBRT + boost improved OS and iPFS in SCLC patients with BM. High BED (>58.35 Gy) for WBRT + boost may be a reasonable consideration for SCLC patients with BM.
本研究旨在评估全脑放疗（WBRT）与全脑放疗联合局部放疗增敏（WBRT + 增敏）的生存结局，并进一步确定WBRT + 增敏的更高生物等效剂量（BED）是否能为小细胞肺癌（SCLC）脑转移（BM）患者带来生存获益。
回顾性分析2012年1月1日至2019年12月31日期间患有BM的SCLC患者。采用Kaplan-Meier法评估总生存期（OS）和颅内无进展生存期（iPFS），并通过对数秩检验进行比较。使用Cox比例风险回归模型对OS的预后因素进行单因素和多因素回归分析。通过受试者工作特征（ROC）曲线分析确定BED的临界值。
在180例符合条件的患者中，82例接受了WBRT + 增敏，98例接受了WBRT。WBRT + 增敏组的OS和iPFS均显著优于WBRT组（中位OS：20.14个月，P = 0.011；中位iPFS：16.10个月，P = 0.003）。在WBRT + 增敏组中，临界值为58.35 Gy，高BED（>58.35 Gy）组52例，低BED（≤58.35 Gy）组30例。与WBRT + 增敏组中的低BED相比，高BED与改善的OS和iPFS显著相关（中位OS：23.17个月，P = 0.002；中位iPFS：17.10个月，P = 0.002）。
与单纯WBRT相比，WBRT + 增敏改善了SCLC脑转移患者的OS和iPFS。对于SCLC脑转移患者，WBRT + 增敏的高BED（>58.35 Gy）可能是一个合理的考虑因素。
