Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
Department of Oncology, Xiangya Boai Hospital, Changsha, China.
CNS Neurosci Ther. 2024 Nov;30(11):e70102. doi: 10.1111/cns.70102.
Extensive-stage small cell lung cancer (ES-SCLC) is a notoriously aggressive malignancy frequently associated with brain metastases (BMs), presenting substantial therapeutic challenges. This study delves into the effectiveness of immunotherapy combined with diverse radiotherapy, especially the influence of brain radiotherapy (BRT) on survival outcomes in the immunotherapy era.
ES-SCLC patients treated at Xiangya Hospital and Xiangya Boai Hospital from February 2020 to June 2024 were retrospectively included. The study focused on patients receiving immune checkpoint inhibitors (ICIs). Metrics included overall survival (OS) and progression-free survival (PFS), employing univariate and multivariate Cox regression models for statistical analysis.
A total of 393 patients with ES-SCLC who received ICIs were included in the study. Within the entire cohort, the presence of baseline BMs did not statistically affect OS or PFS. However, thoracic radiotherapy (TRT) was identified as a favorable prognostic factor for both OS and PFS. BRT demonstrated a beneficial effect on OS across both the general cohort and the baseline_BMs subgroup. In patients from the baseline_BMs subgroup who had previously undergone TRT, ICIs plus BRT did not significantly improve OS compared to ICIs alone. Conversely, for patients who had not received prior TRT, adding BRT to ICIs significantly enhanced OS. Among the patients who underwent BRT, 71 received whole brain radiotherapy (WBRT) while 19 opted for stereotactic radiosurgery (SRS). No significant differences in OS and PFS were observed between the SRS and WBRT modalities. The sequence of ICIs relative to BRT was found to influence PFS adversely. Administering BRT before ICIs (RT-ICI) was associated with worse PFS compared to administering ICIs followed by BRT (ICI-RT). Additionally, no significant differences in OS and PFS were noted among the three subgroups defined by varying intervals between ICIs and BRT. For patients without baseline BMs, TRT and prophylactic cranial irradiation were associated with delayed onset of brain metastases.
Our study underscores the importance of optimizing treatment strategies and considering the timing and integration of radiotherapy and immunotherapy to improve outcomes for patients with ES-SCLC, particularly those at risk of or presenting with BMs.
广泛期小细胞肺癌（ES-SCLC）是一种恶性程度极高的肿瘤，常伴有脑转移（BMs），治疗极具挑战性。本研究探讨了免疫治疗联合多种放疗的疗效，尤其是在免疫治疗时代，脑放疗（BRT）对生存结果的影响。
回顾性纳入 2020 年 2 月至 2024 年 6 月在湘雅医院和湘雅博爱医院接受治疗的 ES-SCLC 患者。本研究重点关注接受免疫检查点抑制剂（ICIs）治疗的患者。主要终点为总生存（OS）和无进展生存（PFS），采用单因素和多因素 Cox 回归模型进行统计学分析。
共纳入 393 例接受 ICIs 治疗的 ES-SCLC 患者。全队列中，基线时存在 BMs 对 OS 和 PFS 无统计学影响。然而，胸部放疗（TRT）是 OS 和 PFS 的有利预后因素。BRT 对全队列和基线_BMs 亚组的 OS 均有益。在接受过 TRT 的基线_BMs 亚组患者中，ICIs 联合 BRT 与单独使用 ICIs 相比，OS 无显著改善。相反，对于未接受过 TRT 的患者，联合使用 BRT 可显著提高 OS。在接受 BRT 的患者中，71 例接受全脑放疗（WBRT），19 例接受立体定向放疗（SRS）。SRS 和 WBRT 模式在 OS 和 PFS 方面无显著差异。ICIs 和 BRT 的应用顺序对 PFS 有不利影响。与先给予 BRT 后给予 ICIs（RT-ICI）相比，先给予 ICIs 后给予 BRT（ICI-RT）的 PFS 更差。此外，在根据 ICIs 和 BRT 之间的不同间隔时间定义的三个亚组中，OS 和 PFS 无显著差异。对于无基线 BMs 的患者，TRT 和预防性颅照射与脑转移的延迟发生相关。
本研究强调了优化治疗策略的重要性，同时考虑放疗和免疫治疗的时机和整合，以改善 ES-SCLC 患者的生存结果，尤其是那些有或有发生 BMs 风险的患者。
