Glantz M J, Choy H, Yee L
Department of Medicine, Brown University School of Medicine, Providence, RI, USA.
Semin Oncol. 1997 Aug;24(4):477-83.
The utility of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC) constitutes one of the longest running debates in oncology. Despite dozens of prospective and retrospective studies and decades of individual experience, a consensus has been reached on only two issues: (1) when administered to all patients with SCLC, PCI decreases the likelihood of developing brain metastases by about half, but (2) PCI does not significantly prolong survival. Uncertainty persists over many critical questions, including whether, when, and how to administer PCI; whether identifiable subgroups of patients benefit more tangibly from PCI; how frequent and severe the long-term side effects of PCI are; whether withholding treatment until brain metastases are diagnosed is clinically responsible and cost effective; and how newer forms of treatment for brain metastases should be integrated into the picture. In this review, we discuss the epidemiology and natural history of brain metastases in patients with SCLC, the results of studies examining the efficacy of PCI, data on the early and late toxicities of PCI, and the status of alternative therapies for patients with brain metastases from SCLC. Based on this information, an approach to newly diagnosed patients is suggested, and recommendations for future study are made.
预防性颅脑照射（PCI）在小细胞肺癌（SCLC）患者中的应用一直是肿瘤学领域持续时间最长的争论之一。尽管有几十项前瞻性和回顾性研究以及数十年的个人经验，但仅在两个问题上达成了共识：（1）对所有SCLC患者进行PCI时，可将发生脑转移的可能性降低约一半，但（2）PCI并不能显著延长生存期。许多关键问题仍然存在不确定性，包括是否、何时以及如何进行PCI；是否有可识别的患者亚组能从PCI中更切实地获益；PCI的长期副作用有多频繁和严重；在脑转移被诊断之前延迟治疗在临床上是否合理且具有成本效益；以及如何将脑转移的新型治疗方法纳入考量。在本综述中，我们讨论了SCLC患者脑转移的流行病学和自然史、检验PCI疗效的研究结果、PCI早期和晚期毒性的数据，以及SCLC脑转移患者替代疗法的现状。基于这些信息，我们提出了针对新诊断患者的方法，并对未来研究提出了建议。
