Department of Infectious Disease, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China; Zhejiang Key Laboratory of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.
Clin Lung Cancer. 2024 Dec;25(8):690-698.e2. doi: 10.1016/j.cllc.2024.08.005. Epub 2024 Aug 13.
Recent advancements in magnetic resonance imaging (MRI) for staging have highlighted the critical question of the need for prophylactic cranial irradiation (PCI) in managing early to mid-stage small cell lung cancer (SCLC). This study assesses the impact of PCI on overall survival (OS) and intracranial control among patients with stage I-IIB SCLC.
Data from 148 stage I-IIB SCLC patients treated with thoracic radiation therapy (TRT) at two centers were examined. Patients were categorized based on PCI administration: 63 received PCI, while 85 did not. All underwent pretreatment MRI, achieving at least a partial response to therapy. A 1:1 propensity score matching analysis corrected for potential biases.
Propensity scores were generated to 116 patients, considering patient demographics, disease progression, and treatment methods. Death was included as a competing risk. The 3-year brain metastases (BM) occurrence rate was significantly higher in patients who did not receive PCI (30.0%) compared to those who did (14.8%), however, the difference was not statistically significant (No PCI vs. PCI, hazard ratio [HR]: 2.08, 95% CI [0.93-4.55], P = .07). No significant effect of PCI on OS was observed [PCI vs. No PCI, HR: 0.80, 95% CI (0.45-1.43), P = .45]. A subgroup analysis of stage IIB patients showed a significant increase in BM risk and mortality for those not receiving PCI (No PCI vs. PCI, BM risk HR: 5.85, 95% CI: 1.83-18.87, P = .003; mortality HR: 2.78, 95% CI: 1.14-6.67, P = .02), with less pronounced effects in stages I-IIA.
With modern MRI-based screening, PCI may markedly benefit stage IIB SCLC patients by reducing BM and improving OS after initial sensitive treatment. This benefit does not appear to extend to stage I-IIA patients.
磁共振成像（MRI）在分期方面的最新进展突出了一个关键问题，即对于早期到中期小细胞肺癌（SCLC）的管理，是否需要预防性颅脑照射（PCI）。本研究评估了 PCI 对 I 期-IIB 期 SCLC 患者总生存（OS）和颅内控制的影响。
检查了两个中心接受胸部放射治疗（TRT）的 148 例 I 期-IIB SCLC 患者的数据。根据 PCI 管理将患者分为两组：63 例接受 PCI，85 例未接受。所有患者均接受了预处理 MRI，治疗后至少达到部分缓解。采用 1:1 倾向评分匹配分析校正潜在偏倚。
考虑到患者人口统计学、疾病进展和治疗方法，为 116 例患者生成了倾向评分。将死亡作为竞争风险。未接受 PCI 的患者 3 年内脑转移（BM）发生率明显高于接受 PCI 的患者（30.0% vs. 14.8%），但差异无统计学意义（无 PCI 组 vs. PCI 组，危险比[HR]：2.08，95%CI [0.93-4.55]，P=0.07）。未观察到 PCI 对 OS 有显著影响[PCI 组 vs. 无 PCI 组，HR：0.80，95%CI（0.45-1.43），P=0.45]。对 IIB 期患者的亚组分析显示，未接受 PCI 的患者 BM 风险和死亡率显著增加（无 PCI 组 vs. PCI 组，BM 风险 HR：5.85，95%CI：1.83-18.87，P=0.003；死亡率 HR：2.78，95%CI：1.14-6.67，P=0.02），而在 I 期-IIA 期患者中影响较小。
基于现代 MRI 筛查，PCI 可能通过降低 BM 并改善初始敏感治疗后的 OS，使 IIB 期 SCLC 患者显著受益。但这种益处似乎不适用于 I 期-IIA 期患者。
