Gregor A
Department of Clinical Oncology, Western General Hospital Trust, Edinburgh, Scotland, UK.
Oncology (Williston Park). 1998 Jan;12(1 Suppl 2):19-24.
Prophylactic cranial irradiation (PCI) is being reintroduced into multimodality treatment protocols of patients with small-cell lung cancer (SCLC). The history of its use brings interesting insights into clinical evaluations of treatment strategies and design of relevant and informative trials. The critical issues of effectiveness and overall health gains of prophylactic cranial irradiation have been addressed in a series of recently completed clinical trials. These trials tested prophylactic cranial irradiation in small-cell lung cancer patients achieving good response to induction therapy and confirmed the ability of standard prophylactic cranial irradiation schedules to significantly reduce the lifetime risk of brain metastases. A subset of these trials evaluated neurotoxicity in a formal and prospective manner. No sustained or significant detriment in neuropsychometric function could be linked to the use of prophylactic cranial irradiation. In addition, all the large trials have shown a consistent survival advantage in favor of the prophylactic cranial irradiation arm. None of the individual sample sizes were large enough to statistically confirm this survival benefit, but a meta-analysis is in progress and will report on this aspect of evidence shortly. Issues that remain to be answered are the optimal dose and schedule of prophylactic cranial irradiation as well as the timing of this administration. These questions form the nucleus of the next generation of collaborative trials that are being designed.
预防性颅脑照射（PCI）正重新被纳入小细胞肺癌（SCLC）患者的多模式治疗方案中。其使用历史为治疗策略的临床评估以及相关信息丰富的试验设计带来了有趣的见解。一系列近期完成的临床试验探讨了预防性颅脑照射的有效性和总体健康获益等关键问题。这些试验在对诱导治疗有良好反应的小细胞肺癌患者中测试了预防性颅脑照射，并证实标准的预防性颅脑照射方案能够显著降低脑转移的终生风险。其中一部分试验以正式且前瞻性的方式评估了神经毒性。未发现预防性颅脑照射的使用与神经心理测量功能的持续或显著损害有关。此外，所有大型试验均显示预防性颅脑照射组具有一致的生存优势。单个样本量均不足以从统计学上证实这种生存获益，但一项荟萃分析正在进行中，不久将报告这方面的证据。有待解答的问题包括预防性颅脑照射的最佳剂量和方案以及给药时机。这些问题构成了正在设计的下一代协作试验的核心。
