Yao Yuanhu, Yao Nan, Qin Zhaohui, Ma Ji, Lu Jiaying, Cui Li, Qu Wanxi, Yuan Shiwang, Tong Shaodong, Li Na, Li Hao
Department of Radiation Oncology The Affiliated Wuxi People's Hospital of Nanjing Medical University Wuxi Jiangsu China.
Graduate School of Xuzhou Medical University Xuzhou Jiangsu China.
Precis Radiat Oncol. 2023 Jun 21;7(2):111-117. doi: 10.1002/pro6.1200. eCollection 2023 Jun.
The role of prophylactic cranial irradiation (PCI) in treating extensive-stage small-cell lung cancer (ES-SCLC) has been controversial. This study aimed to comprehensively analyze the efficacy of PCI for the treatment of ES-SCLC under active brain magnetic resonance imaging (MRI) surveillance.
Patients with ES-SCLC with no brain metastases (BM) confirmed by MRI at the time of diagnosis who responded well to first-line chemoimmunotherapy at three general hospitals were retrospectively included. Overall survival (OS), progression-free survival (PFS), and cumulative incidence of BM were compared between patients who underwent PCI and those who did not.
In total, 66 consecutive patients treated between March 2019 and December 2021 were included in our dataset. Seventeen patients underwent PCI (PCI group) and 49 patients did not (non-PCI group). In comparison with the non-PCI group, PCI did not provide OS (median OS: 18.53 . 17.35 months, = 0.28) or PFS (median PFS: 8.61 . 7.56 months, = 0.41) benefits. When death was counted as a competing risk, the difference in the cumulative incidence rate of BM was not statistically significant (1-year: 12.79% . 38.09%; = 0.14).
Compared to active MRI surveillance, first-line chemoimmunotherapy followed by PCI did not improve the prognosis of patients with ES-SCLC. Further studies are warranted to evaluate the therapeutic effects of PCI following chemoimmunotherapy.
预防性颅脑照射（PCI）在广泛期小细胞肺癌（ES-SCLC）治疗中的作用一直存在争议。本研究旨在在积极的脑磁共振成像（MRI）监测下，全面分析PCI治疗ES-SCLC的疗效。
回顾性纳入三家综合医院中诊断时经MRI证实无脑转移（BM）且对一线化疗免疫治疗反应良好的ES-SCLC患者。比较接受PCI和未接受PCI患者的总生存期（OS）、无进展生存期（PFS）和BM累积发生率。
我们的数据集中共纳入了2019年3月至2021年12月期间连续治疗的66例患者。17例患者接受了PCI（PCI组），49例患者未接受（非PCI组）。与非PCI组相比，PCI未带来OS（中位OS：18.53对17.35个月，P=0.28）或PFS（中位PFS：8.61对7.56个月，P=0.41）益处。将死亡视为竞争风险时，BM累积发生率差异无统计学意义（1年：12.79%对38.09%；P=0.14）。
与积极的MRI监测相比，一线化疗免疫治疗后行PCI并未改善ES-SCLC患者的预后。有必要进一步研究评估化疗免疫治疗后PCI的治疗效果。
