Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Neurooncol. 2023 Nov;165(2):343-351. doi: 10.1007/s11060-023-04512-2. Epub 2023 Nov 20.
To elucidate treatment patterns and their outcomes in patients with small cell lung cancer (SCLC) and brain metastasis (BM).
In this retrospective study, patients with SCLC and BM were stratified by treatment modality into three groups: those treated with systemic therapy only, those treated with stereotactic radiosurgery (SRS) and systemic therapy, and those treated with whole-brain radiotherapy (WBRT) and systemic therapy. The primary outcomes were overall survival (OS) and time to central nervous system progression (TTCP).
The analysis included 149 patients. After BM diagnosis, 48 patients (32.2%) received systemic therapy alone, 33 received SRS with systemic therapy, and 68 received WBRT with systemic therapy. The median OS and TTCP were 7.2 months and 8.7 months, respectively. Patients receiving WBRT with systemic therapy exhibited better intracranial control, but not better OS, than did the other patients. Key prognostic factors affecting OS were age, BM lesion count, chemotherapy, and immunotherapy. Notably, the Eastern Cooperative Oncology Group performance status and BM lesion count significantly influenced intracranial control in patients treated with SRS and systemic therapy.
Although WBRT combined with systemic therapy offer better intracranial control in patients with SCLC and BM, this approach is not superior to the other approaches in terms of OS benefits. Emerging systemic therapies, such as immunotherapy, may be used as alternative or adjunctive treatments for specific patient populations. Further studies are warranted to refine treatment selection.
阐明小细胞肺癌（SCLC）伴脑转移（BM）患者的治疗模式及其结局。
本回顾性研究根据治疗方式将 SCLC 伴 BM 患者分为三组：单纯全身治疗组、立体定向放疗（SRS）联合全身治疗组和全脑放疗（WBRT）联合全身治疗组。主要结局指标为总生存期（OS）和中枢神经系统进展时间（TTCP）。
分析纳入 149 例患者。在诊断为 BM 后，48 例（32.2%）患者接受单纯全身治疗，33 例患者接受 SRS 联合全身治疗，68 例患者接受 WBRT 联合全身治疗。中位 OS 和 TTCP 分别为 7.2 个月和 8.7 个月。与其他治疗组相比，接受 WBRT 联合全身治疗的患者颅内控制情况更好，但 OS 无显著改善。影响 OS 的关键预后因素包括年龄、BM 病灶数量、化疗和免疫治疗。值得注意的是，Eastern Cooperative Oncology Group 表现状态和 BM 病灶数量显著影响接受 SRS 和全身治疗患者的颅内控制情况。
尽管 WBRT 联合全身治疗可为 SCLC 伴 BM 患者提供更好的颅内控制，但在 OS 获益方面，该方法并不优于其他方法。新兴的全身治疗方法，如免疫治疗，可能成为特定患者群体的替代或辅助治疗方法。需要进一步研究来优化治疗选择。
