Brewster A E, Hopwood P, Stout R, Burt P A, Thatcher N
Department of Radiotherapy, Christie Hospital, Manchester, UK.
Radiother Oncol. 1995 Feb;34(2):132-6. doi: 10.1016/0167-8140(95)01513-g.
The effectiveness of a single 8-Gy fraction prophylactic cranial irradiation regime was assessed in 106 patients with small-cell carcinoma of the lung. All patients had limited stage disease and received combination chemotherapy consisting of either cisplatin or carboplatin with ifosfamide, etoposide, and vincristine (VICE). Cranial irradiation was administered 48 h after the first cycle of chemotherapy and was well tolerated. Actual 2-year survival was 35% and cranial relapse occurred in 22% of those patients who achieved complete remission. This compares favourably with a cranial relapse rate of 45% incomplete remitters previously reported with the same chemotherapy regime after a minimum follow-up of 2 years where PCI was not used. Formal psychometric testing was performed retrospectively on a series of 25 long-term survivors of whom 14 were taken from this reported series. Whilst 75% of patients were impaired on at least one test with 68% performing badly in the most complex task, this was not associated with clinically detectable neurological damage and the patients did not complain of memory or concentration difficulties. In conclusion, single fraction PCI, when used with platinum based combination chemotherapy, appears to be equally effective but may be less neurotoxic than the more standard fractionated regimes.
对106例小细胞肺癌患者评估了单次8 Gy预防性全脑照射方案的有效性。所有患者均为局限期疾病，接受了由顺铂或卡铂联合异环磷酰胺、依托泊苷和长春新碱（VICE）组成的联合化疗。全脑照射在化疗第一周期后48小时进行，耐受性良好。实际2年生存率为35%，在达到完全缓解的患者中，22%发生了脑转移。这与之前报道的在未使用预防性全脑照射（PCI）且至少随访2年的情况下，相同化疗方案的不完全缓解者45%的脑转移率相比更有利。对一系列25例长期存活者进行了回顾性正式心理测量测试，其中14例来自本报道系列。虽然75%的患者至少在一项测试中表现受损，68%的患者在最复杂任务中表现不佳，但这与临床上可检测到的神经损伤无关，患者也未抱怨记忆或注意力困难。总之，与基于铂的联合化疗联合使用时，单次分割PCI似乎同样有效，但可能比更标准的分割方案神经毒性更小。
