He Dan, Wei Shuxia, Geng Fenghao, Li Lintao, Li Fengyu, Ge Yanli, Lv Ruichang, Li Weiwei, Hao Zhijun, Jiang Fengdi, Meng Chao, Lu Shun, Zhang Shuyu
Department of Oncology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610041, P.R. China.
Department of Radiation Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China.
Oncol Lett. 2025 May 2;30(1):327. doi: 10.3892/ol.2025.15073. eCollection 2025 Jul.
Prophylactic cerebral irradiation (PCI) reduces the rate of brain metastasis and improves the prognosis of patients with small cell lung cancer (SCLC), but little is known about the effect of PCI on second-line chemotherapy in patients with relapsed sensitive SCLC. This retrospective cohort study included a total of 164 patients with relapsed sensitive SCLC, 20 of whom were administered temozolomide (TMZ). Categorical clinical variables were compared between subgroups with the chi-square test or Fisher's exact test, continuous clinical variables were compared with the t-test or one-way ANOVA, and the impact on overall survival (OS) was assessed using Kaplan-Meier analysis with the log-rank test. In general, TMZ prolonged the OS of patients with SCLC with brain metastasis from 12.0 to 19.0 months [P=0.0109, hazard ratio (HR): 0.4789, 95% CI: 0.2470-0.9287]. Furthermore, the administration of PCI improved the effects of TMZ on patients with SCLC with brain metastasis, with an increase in OS from 16.0 to 36.5 months (P=0.0017, HR: 3.634, 95% CI: 1.083-12.20); additionally, no difference was observed on the basis of the history of chemotherapy or state of brain metastasis. For the local response evaluation, the overall response rate reached 75.0% for both brain metastasis and extracranial lesions in the two-cycle evaluation, remained at 30.0 and 25.0% in the four-cycle and more-cycle evaluations, respectively, and was minimally influenced by the history of chemotherapy or PCI. In conclusion, the results of this study suggest that PCI may be valuable for patients with relapsed sensitive SCLC with brain metastasis who are receiving TMZ treatment, and it may also serve as an effective regimen to prevent local progression of extracranial lesions; however, more evidence is needed.
预防性脑照射（PCI）可降低小细胞肺癌（SCLC）患者脑转移率并改善其预后，但关于PCI对复发敏感SCLC患者二线化疗的影响知之甚少。这项回顾性队列研究共纳入164例复发敏感SCLC患者，其中20例接受了替莫唑胺（TMZ）治疗。分类临床变量在亚组间采用卡方检验或Fisher精确检验进行比较，连续临床变量采用t检验或单因素方差分析进行比较，并使用Kaplan-Meier分析和对数秩检验评估对总生存期（OS）的影响。总体而言，TMZ将有脑转移的SCLC患者的OS从12.0个月延长至19.0个月[P = 0.0109，风险比（HR）：0.4789，95%置信区间（CI）：0.2470 - 0.9287]。此外，PCI的应用改善了TMZ对有脑转移的SCLC患者的疗效，OS从16.0个月增加到36.5个月（P = 0.0017，HR：3.634，95%CI：1.083 - 12.20）；此外，根据化疗史或脑转移状态未观察到差异。对于局部反应评估，在两周期评估中脑转移和颅外病变的总体反应率均达到75.0%，在四周期及更多周期评估中分别保持在30.0%和25.0%，且受化疗史或PCI的影响最小。总之，本研究结果表明，PCI对于接受TMZ治疗的复发敏感且有脑转移的SCLC患者可能有价值，也可能是预防颅外病变局部进展的有效方案；然而，还需要更多证据。
