磁共振成像时代局限期小细胞肺癌的预防性颅脑照射。

Prophylactic cranial irradiation for limited-stage small-cell lung cancer in the magnetic resonance imaging era.

机构信息

Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.

Department of Oncology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.

出版信息

Cancer Med. 2023 Feb;12(3):2484-2492. doi: 10.1002/cam4.5082. Epub 2022 Jul 27.

DOI:10.1002/cam4.5082

PMID:35894822

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9939136/

Abstract

BACKGROUND

We investigated the role of prophylactic cranial irradiation (PCI) in limited-stage small-cell lung cancer (LS-SCLC) according to tumor response in the magnetic resonance imaging (MRI) era.

METHODS

We retrospectively evaluated patients with LS-SCLC without brain metastases (BMs) on MRI who achieved either complete response (CR) or partial response (PR) after initial chemoradiotherapy at our center from 2006 to 2017.

RESULTS

This study comprised 116 patients (median age, 58 years; men, 92; women, 24). After initial chemoradiotherapy, 53 patients achieved CR, while 63 patients achieved PR. Eighty-three patients received PCI. Patients who received PCI had better overall survival (OS, 5-year: 52.5% vs. 35.1%; p = 0.012) and progression-free survival (PFS, 5-year: 45.0% vs. 28.2%; p = 0.001) and a lower incidence of BMs (5-year: 18.3% vs. 39.4%; p = 0.010). In the subgroup analysis, PCI improved OS (5-year: 67.8% vs. 46.7%, p = 0.005) and PFS (5-year: 65.2% vs. 35.0%, p = 0.021) and decreased BM risk (5-year: 12.1% vs. 52.4%, p = 0.002) for patients with CR. However, PCI had no benefit (5-year OS: 40.5% vs. 35.6%, p = 0.763; 5-year BMs: 24.6% vs. 31.9%, p = 0.561) for patients with PR.

CONCLUSIONS

Tumor response remained an important factor for selecting patients for PCI in the MRI era. PCI should be recommended for patients with LS-SCLC who achieve CR after initial thoracic chemoradiotherapy.

摘要

背景

我们研究了在 MRI 时代，根据肿瘤对初始放化疗的反应，预防性颅脑照射（PCI）在局限期小细胞肺癌（LS-SCLC）中的作用。

方法

我们回顾性评估了 2006 年至 2017 年期间在我们中心接受初始放化疗后 MRI 上无脑转移（BM）且达到完全缓解（CR）或部分缓解（PR）的 LS-SCLC 患者。

结果

本研究共纳入 116 例患者（中位年龄 58 岁；男性 92 例，女性 24 例）。初始放化疗后，53 例患者达到 CR，63 例患者达到 PR。83 例患者接受了 PCI。接受 PCI 的患者具有更好的总生存期（OS，5 年：52.5% vs. 35.1%；p=0.012）和无进展生存期（PFS，5 年：45.0% vs. 28.2%；p=0.001），且 BM 发生率较低（5 年：18.3% vs. 39.4%；p=0.010）。亚组分析显示，PCI 改善了 CR 患者的 OS（5 年：67.8% vs. 46.7%；p=0.005）和 PFS（5 年：65.2% vs. 35.0%；p=0.021），并降低了 BM 风险（5 年：12.1% vs. 52.4%；p=0.002）。然而，对于 PR 患者，PCI 无获益（5 年 OS：40.5% vs. 35.6%；p=0.763；5 年 BM：24.6% vs. 31.9%；p=0.561）。