Liengswangwong V, Bonner J A, Shaw E G, Foote R L, Frytak S, Richardson R L, Creagan E T, Eagan R T, Su J Q
Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota 55905.
Cancer. 1995 Mar 15;75(6):1302-9. doi: 10.1002/1097-0142(19950315)75:6<1302::aid-cncr2820750612>3.0.co;2-e.
The role of prophylactic cranial irradiation (PCI) for patients with limited-stage small cell lung cancer (LSSCLC) remains a controversial issue. This study evaluated PCI in patients with LSSCLC who achieved a complete response to initial chemotherapy.
A retrospective case study of all nonprotocol patients with LSSCLC examined at our institution from 1982 to 1990 was performed. Of the 67 nonprotocol patients who were treated with combination chemotherapy (cyclophosphamide-based) and thoracic radiotherapy during those years, 43 achieved a complete response. Twenty-four patients received prophylactic cranial irradiation (PCI+) (25-36 Gy in 10-16 fractions), and 19 did not (PCI-) at the physician's or patient's discretion.
The distribution of prognostic factors between the PCI+ and PCI- groups was well balanced. Of the PCI+ patients, the 2-year actuarial freedom from relapse in the central nervous system was 93% versus 47% for the PCI- patients (log rank analysis, P = 0.001). An initial central nervous system relapse developed in 2 of the 24 PCI+ patients as the only site of failure versus 7 of 19 PCI- patients (P = 0.003). The 2-year actuarial overall survival was 50% for the PCI+ patients versus 21% for the PCI- patients (P = 0.01). The addition of prophylactic cranial irradiation was the only significant factor contributing to an improvement in time to central nervous system relapse and survival for the PCI+ patients. There were five patients alive at the time of this report, and all received prophylactic cranial irradiation. None had cognitive or neurologic impairment.
Prophylactic cranial irradiation may contribute to improved survival in patients with LSSCLC who achieve a complete response after chemotherapy and thoracic radiation therapy.
预防性颅脑照射（PCI）在局限期小细胞肺癌（LSSCLC）患者中的作用仍是一个有争议的问题。本研究评估了初始化疗后达到完全缓解的LSSCLC患者接受PCI的情况。
对1982年至1990年在本机构接受检查的所有非方案LSSCLC患者进行回顾性病例研究。在那些年接受联合化疗（以环磷酰胺为基础）和胸部放疗的67例非方案患者中，43例达到完全缓解。24例患者接受预防性颅脑照射（PCI+组）（25 - 36 Gy，分10 - 16次），19例患者未接受（PCI-组），由医生或患者自行决定。
PCI+组和PCI-组的预后因素分布均衡。PCI+组患者2年中枢神经系统无复发生存率为93%，而PCI-组为47%（对数秩检验，P = 0.001）。24例PCI+组患者中有2例仅以中枢神经系统复发作为唯一失败部位，而19例PCI-组患者中有7例（P = 0.003）。PCI+组患者2年总生存率为50%，PCI-组为21%（P = 0.01）。预防性颅脑照射的加入是PCI+组患者中枢神经系统复发时间和生存率改善的唯一显著因素。在本报告时，有5例患者存活，均接受了预防性颅脑照射。均无认知或神经功能损害。
预防性颅脑照射可能有助于改善化疗和胸部放疗后达到完全缓解的LSSCLC患者的生存率。
