局限野放疗对小细胞肺癌患者复发性脑转移的有效性

Effectivity of involved-field radiotherapy for recurrent brain metastasis in patients with small-cell lung cancer.

作者信息

Wang Yu, Song JiXiang, Li Wanhu, Zeng Haiyan, Liu Ning, Zhu Shouhui, Yuan Shuanghu, Hu Xudong

机构信息

Somatic Radiotherapy Department, Shandong Second Provincial General Hospital, Shandong Provincial ENT Hospital, Jinan, Shandong, China.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences; Department of Medical Administration, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.

出版信息

J Cancer Res Ther. 2022 Sep;18(5):1276-1285. doi: 10.4103/jcrt.jcrt_185_22.

DOI:10.4103/jcrt.jcrt_185_22

PMID:36204873

Abstract

OBJECTIVES

To investigate the outcome difference of whole brain radiotherapy (WBRT) and involved-field radiotherapy (IFRT) in limited-stage small-cell lung cancer (LS-SCLC) patients with recurrent brain metastases (BMs) after prophylactic cranial irradiation (PCI).

METHODS

A retrospective analysis was carried out in 68 LS-SCLC patients who underwent WBRT or IFRT owing to the occurrence of recurrent BMs after PCI from 2009 to 2020.

RESULTS

The median overall survival (OS) of all patients was 11.43 months [95% confidence interval (CI) 9.39-13.48 months]. In the paired comparison of OS, the IFRT group had a significantly longer survival time than the WBRT group in all patients [17.80 months vs. 8.47 months; hazard ratio (HR), 0.393, 95% CI, 0.213-0.728; P = 0.002] and 46 matched patients (18.23 months vs. 8.73 months; HR, 0.411, 95% CI, 0.195-0.865; P = 0.019). In terms of the intra-cranial progression-free survival (iPFS), there was no significant difference between the WBRT group and IFRT group before matching (5.93 months vs. 7.30 months; HR, 0.644, 95% CI, 0.373-1.112; P = 0.111); similarly, no statistical difference was detected between the WBRT group and IFRT group after matching (5.33 months vs. 8.10 months; HR, 0.623, 95% CI, 0.323-1.199; P = 0.152). Meanwhile, of the 41 patients with symptoms, 27 cases (65.9%) had symptom relief, showing tolerable toxicity without unexpected toxicity during the observation.

CONCLUSIONS

Compared with WBRT, IFRT exhibits better survival benefits for LS-SCLC patients with recurrent BMs after PCI. Re-irradiation for BMs exhibits advantages of symptom relief and tolerable side effects.

摘要

目的

探讨全脑放疗（WBRT）与累及野放疗（IFRT）在接受过预防性颅脑照射（PCI）后发生复发性脑转移（BMs）的局限期小细胞肺癌（LS-SCLC）患者中的疗效差异。

方法

对2009年至2020年期间因PCI后发生复发性BMs而接受WBRT或IFRT的68例LS-SCLC患者进行回顾性分析。

结果

所有患者的中位总生存期（OS）为11.43个月[95%置信区间（CI）9.39 - 13.48个月]。在OS的配对比较中，IFRT组在所有患者中的生存时间显著长于WBRT组[17.80个月对8.47个月；风险比（HR），0.393，95%CI，0.213 - 0.728；P = 0.002]以及46例匹配患者（18.23个月对8.73个月；HR，0.411，95%CI，0.195 - 0.865；P = 0.019）。在颅内无进展生存期（iPFS）方面，匹配前WBRT组与IFRT组之间无显著差异（5.93个月对7.30个月；HR，0.644，95%CI，0.373 - 1.112；P = 0.111）；同样，匹配后WBRT组与IFRT组之间也未检测到统计学差异（5.33个月对8.10个月；HR，0.623，95%CI，0.323 - 1.199；P = 0.152）。同时，在41例有症状的患者中，27例（65.9%）症状得到缓解，在观察期间显示出可耐受的毒性且无意外毒性。