Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom.
Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Lung Cancer. 2021 Dec;162:96-105. doi: 10.1016/j.lungcan.2021.10.016. Epub 2021 Nov 6.
Small cell lung cancer (SCLC) is an aggressive form of lung cancer associated with an increased risk of develping brain metastases (BM), which are a significant cause of morbidity and mortality. Prophylactic cranial irradiation (PCI) was first introduced in the 1970s with the aim of reducing BM incidence and improving survival and quality of life (QoL). Prospective clinical trials and meta-analyses have demonstrated its effectiveness in reducing BM incidence and improving survival, across all stages of the disease following response to induction chemotherapy. Despite its long history, "unknowns" surrounding PCI use still exist and there are particular subgroups of patients for which its use remains controversial. PCI is known to cause neurocognitive toxicity which can have a significant impact on a patient's QoL. Strategies to minimise this, including the use of hippocampal avoidance radiotherapy techniques, neuroprotective drugs and stereotactic radiosurgery in place of whole brain radiotherapy for the treatment of BM, are under evaluation. This review offers a summary of the key PCI trials published to date and the current treatment recommendations based on available evidence. It also discusses the key questions being addressed in ongoing clinical trials and highlights others where there is currently a knowledge gap and therefore where further data are urgently required.
小细胞肺癌（SCLC）是一种侵袭性肺癌，其发生脑转移（BM）的风险增加，脑转移是发病率和死亡率的重要原因。预防性颅脑照射（PCI）于 20 世纪 70 年代首次引入，目的是降低 BM 的发生率，提高生存率和生活质量（QoL）。前瞻性临床试验和荟萃分析表明，在诱导化疗后疾病各阶段，它在降低 BM 的发生率和提高生存率方面具有有效性。尽管 PCI 的应用历史悠久，但仍存在一些“未知”因素，并且对于某些特定患者群体，其应用仍然存在争议。PCI 会导致神经认知毒性，这会对患者的 QoL 产生重大影响。目前正在评估一些策略来最大程度地减少这种毒性，包括使用海马回避放射治疗技术、神经保护药物和立体定向放射外科治疗 BM，而不是全脑放疗。这篇综述总结了迄今为止发表的关键 PCI 试验和基于现有证据的当前治疗建议。它还讨论了正在进行的临床试验中需要解决的关键问题，并强调了其他存在知识空白的问题，因此迫切需要进一步的数据。
