巩固性胸部放疗治疗广泛期小细胞肺癌患者时预防性颅脑照射的实际应用效果及疗效
Real-world outcomes of prophylactic cranial irradiation utilization and efficacy for patients with extensive-stage small cell lung cancer treated with consolidative thoracic radiotherapy.
作者信息
Lone Abdul H, Salunkhe Rohan, Sugumar Vijithan, Zhan Luna J, Ye Xiang Y, Bezjak Andrea, Cho John, Giuliani Meredith E, Hope Andrew J, Sun Alexander, Raman Srinivas, Bradbury Penelope A, Eng Lawson, Leighl Natasha B, Shepherd Frances A, Sacher Adrian, Liu Geoffrey, Lok Benjamin H
机构信息
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.
William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA.
出版信息
Clin Transl Radiat Oncol. 2025 Jan 7;51:100917. doi: 10.1016/j.ctro.2025.100917. eCollection 2025 Mar.
BACKGROUND
The role of prophylactic cranial irradiation (PCI) is not well-defined in extensive-stage SCLC (ES-SCLC), with conflicting results from randomized trials and a lack of relevant data for patients who received consolidative thoracic radiotherapy (CTRT). We sought to evaluate the impact of PCI on the outcomes of ES-SCLC patients who were all treated with CTRT.
METHODS
A retrospective analysis of ES-SCLC patients without brain metastases who were all treated with CTRT between 2013-2021 at our institution was conducted. Overall survival (OS) and incidence of brain failure (BFR) were estimated using Kaplan-Meier estimation and cumulative incidence function. Multivariable Cox or Fine-Gray's proportional hazard regression analysis (MVA) were performed to determine association between PCI and OS.
RESULTS
47 patients met inclusion criteria and were theoretically eligible for PCI, 27 (57.4 %) received PCI and CTRT while 20 (42.6 %) received CTRT alone. Baseline characteristics were similar except for age, where patients receiving PCI were younger (median age 62) compared to patients who did not receive PCI (median age 72). Median OS with PCI was 19.2 months, compared to 10.8 months without PCI ( 0.0334). This improved OS remained apparent in patients who received post-chemotherapy MRI restaging ( 0.0245). BFR was reduced with PCI (HR = 0.22 [0.09-0.52], = 0.0004). On MVA, PCI was significantly and independently associated with improved OS (HR = 0.39 [0.19-0.80], = 0.01) and reduced BFR (HR = 0.20 [0.09-0.44], = < 0.001).
CONCLUSION
This real-world study found PCI was independently associated with improved OS and reduced BFR in ES-SCLC patients treated with CTRT compared to patients treated with CTRT not receiving PCI, including after post-chemotherapy brain MRI. The role of PCI with CTRT should be evaluated in prospective studies.
背景
预防性颅脑照射（PCI）在广泛期小细胞肺癌（ES-SCLC）中的作用尚未明确，随机试验结果相互矛盾，且缺乏接受巩固性胸部放疗（CTRT）患者的相关数据。我们试图评估PCI对均接受CTRT的ES-SCLC患者预后的影响。
方法
对2013年至2021年期间在我院接受CTRT且无脑转移的ES-SCLC患者进行回顾性分析。采用Kaplan-Meier估计法和累积发病率函数估计总生存期（OS）和脑衰竭发生率（BFR）。进行多变量Cox或Fine-Gray比例风险回归分析（MVA）以确定PCI与OS之间的关联。
结果
47例患者符合纳入标准，理论上 eligible for PCI，27例（57.4%）接受了PCI和CTRT，20例（42.6%）仅接受了CTRT。除年龄外，基线特征相似，接受PCI的患者较未接受PCI的患者年轻（中位年龄62岁 vs 72岁）。接受PCI的患者中位OS为19.2个月，未接受PCI的患者为10.8个月（P = 0.0334）。在接受化疗后MRI重新分期的患者中，这种OS改善仍然明显（P = 0.0245）。PCI降低了BFR（HR = 0.22 [0.09 - 0.52]，P = 0.0004）。在MVA中，PCI与改善的OS显著且独立相关（HR = 0.39 [0.19 - 0.80]，P = 0.01），并降低了BFR（HR = 0.20 [0.09 - 0.44]，P = < 0.001）。
结论
这项真实世界研究发现，与未接受PCI的CTRT治疗患者相比，接受CTRT的ES-SCLC患者中，PCI与改善的OS和降低的BFR独立相关，包括化疗后脑部MRI检查后。PCI联合CTRT的作用应在前瞻性研究中进行评估。
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