Komaki R, Byhardt R W, Anderson T, Libnoch J A, Cox J D, Hansen R, Holoye P Y
Am J Clin Oncol. 1985 Dec;8(6):523-7. doi: 10.1097/00000421-198512000-00013.
Between January 1974 and September 1984, 327 consecutive patients with small cell carcinoma of the lung (SCCL) free of clinical and brain scan (radionuclide or computed tomography) evidence of brain metastasis were treated at the Medical College of Wisconsin Affiliated Hospitals. All patients received single agent chemotherapy, consisting of cyclophosphamide or methotrexate (1974-1975), or combination chemotherapy with cyclophosphamide, doxorubicin, and vincristine with or without methotrexate and leukovorin (1976-1984). Between January 1974 and December 1974, 82 patients were treated with chemotherapy without prophylactic cranial irradiation (PCI). Between 1978 and 1984, all patients received PCI during the first week after diagnosis, simultaneous with their first cycle of chemotherapy. Chest irradiation was given to the complete responders to the chemotherapy. During the first 31/3 years of the study with PCI (January 1978-May 1981), 51 patients received 30 Gray (Gy) in 10 fractions in 2 weeks and five of them (10%) developed brain metastasis. Thereafter, 25 Gy in 10 fractions was consistently administered for PCI. Six of 194 patients (3%) developed brain metastasis. The cumulative (time corrected) probability of brain metastasis was approximately 10% at 1 year and was similar for patients who received 25 Gy and those who received 30 Gy. Although detailed neuropsychological testing has not been performed, clinically apparent late sequelae that might be attributed to PCI have not been seen. Nonetheless, the dose fractionation regimen of 25 Gy in 10 fractions with combination chemotherapy, cyclophosphamide, doxorubicin (or methotrexate), and vincristine is as effective in eliminating subclinical metastasis to the brain. It can be recommended for future trials until more data become available about late sequelae of treatment of SCCL and the patient characteristics and treatment factors that may contribute.
1974年1月至1984年9月期间，威斯康星医学院附属医院连续收治了327例无临床及脑部扫描（放射性核素或计算机断层扫描）脑转移证据的肺小细胞癌（SCCL）患者。所有患者均接受单药化疗，包括环磷酰胺或甲氨蝶呤（1974 - 1975年），或环磷酰胺、阿霉素和长春新碱联合化疗，加或不加甲氨蝶呤和亚叶酸钙（1976 - 1984年）。1974年1月至1974年12月，82例患者接受了无预防性颅脑照射（PCI）的化疗。1978年至1984年期间，所有患者在诊断后的第一周接受PCI，与第一个化疗周期同时进行。对化疗完全缓解者进行胸部照射。在PCI研究的前3又1/3年（1978年1月至1981年5月），51例患者在2周内分10次接受30戈瑞（Gy）照射，其中5例（10%）发生脑转移。此后，PCI一直采用25 Gy分10次照射。194例患者中有6例（3%）发生脑转移。脑转移的累积（时间校正）概率在1年时约为10%，接受25 Gy和30 Gy照射的患者相似。虽然尚未进行详细的神经心理学测试，但尚未观察到可能归因于PCI的明显临床晚期后遗症。尽管如此，25 Gy分10次的剂量分割方案联合环磷酰胺、阿霉素（或甲氨蝶呤）和长春新碱化疗在消除脑亚临床转移方面同样有效。在获得更多关于SCCL治疗晚期后遗症以及可能相关的患者特征和治疗因素的数据之前，可推荐用于未来试验。
