Chen Meng-Yuan, Ji Yongling, Hu Xiao, Chen Ming
Department of Radiation Oncology, Institute of Cancer and Basic Medicine of Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China.
Cancer Manag Res. 2022 May 23;14:1807-1814. doi: 10.2147/CMAR.S347449. eCollection 2022.
Prophylactic cranial irradiation (PCI) can reduce the risk of brain metastases (BM) and improve overall survival (OS) in patients with limited-stage small cell lung cancer (LS-SCLC) after partial or complete response to primary therapy. However, some SCLC patients still develop BM after PCI. This study aimed to evaluate the risk factors of BM in patients with LS-SCLC after PCI and identify characteristics of patients who may not benefit from PCI.
We identified 550 patients with LS-SCLC who received chemoradiotherapy at Zhejiang Cancer Hospital between 2002 and 2017. All patients received PCI. Kaplan-Meier analyses and Cox regression analyses were used to identify factors affecting OS and brain metastasis-free survival (BMFS).
For this patient population, the median survival time was 27.9 months, and the 5-year OS rate was 31%. The median survival time was 24.9 months (95% CI: 22.6-27.2 months), and 30.2 months (95% CI: 24.2-36.3 months) in patients with or without BM (P = 0.000). The overall BM rate was 15.6% (86/550). The frequency of BM in patients with pathologic stages I, II, and III were 9.3% (4/43), 13.4% (7/52), and 16.5% (75/455). The patients with tumors ≥5 cm had an increased risk of BM (HR: 1.781, 95% CI: 1.044-3.039, P = 0.034) but not death (HR: 1.126, 95% CI: 0.925-1.663, P = 0.182). The median survival time among patients <60 years was significantly longer than patients ≥60 years (34.9 months vs 24.6 months, P = 0.001); however, the difference in the BM risk between the two groups was not statistically significant.
PCI remains the standard of care for LS-SCLC patients who achieve complete or partial response after completion of chemoradiotherapy. However, patients with tumors ≥5 cm may have a higher risk of developing BM after PCI.
预防性颅脑照射（PCI）可降低局限期小细胞肺癌（LS-SCLC）患者在对原发治疗部分或完全缓解后发生脑转移（BM）的风险，并改善总生存期（OS）。然而，一些SCLC患者在PCI后仍会发生BM。本研究旨在评估PCI后LS-SCLC患者发生BM的危险因素，并确定可能无法从PCI中获益的患者特征。
我们纳入了2002年至2017年间在浙江省肿瘤医院接受放化疗的550例LS-SCLC患者。所有患者均接受了PCI。采用Kaplan-Meier分析和Cox回归分析来确定影响OS和无脑转移生存期（BMFS）的因素。
对于该患者群体，中位生存时间为27.9个月，5年OS率为31%。有或无BM患者的中位生存时间分别为24.9个月（95%CI：22.6-27.2个月）和30.2个月（95%CI：24.2-36.3个月）（P=0.000）。总体BM发生率为15.6%（86/550）。病理分期为I、II和III期患者的BM发生率分别为9.3%（4/43）、13.4%（7/52）和16.5%（75/455）。肿瘤≥5 cm的患者发生BM的风险增加（HR：1.781，95%CI：1.044-3.039，P=0.034），但死亡风险未增加（HR：1.126，95%CI：0.925-1.663，P=0.182）。<60岁患者的中位生存时间显著长于≥60岁患者（34.9个月对24.6个月，P=0.001）；然而，两组之间的BM风险差异无统计学意义。
PCI仍然是放化疗后达到完全或部分缓解的LS-SCLC患者的标准治疗方法。然而，肿瘤≥5 cm的患者在PCI后发生BM的风险可能更高。
