Pirtoli L, Tucci E, Bellezza A, Volterrani L, Carfagno T, Crastolla A M, Pepi F, Sebaste L
Unità Operativa di Radioterapia, Università e Azienda Ospedaliera Senese, Siena SI.
Radiol Med. 1998 Sep;96(3):244-7.
To assess the role of CT brain scans as a routine restaging procedure after primary, aggressive, drug or radiation therapy of unresectable lung cancer. If early, asymptomatic brain metastases are detected and treated, survival could be improved relative to the patients showing brain involvement in a later CT scan performed during the follow-up, at the onset of neurological symptoms.
One hundred patients affected with lung cancer, unresectable on account of histology (small-cell carcinoma) or advanced stage (III, IV) were submitted to chemo- and/or radiotherapy, after a clinical staging including brain CT, which was negative in all patients. Brain CT was also repeated at the end of therapy (restaging), in the absence of any neurological symptom. Further scans were obtained during the subsequent follow-up only when clinical symptoms occurred, suggesting metastases to the brain. Survival values were analyzed in the patients whose brain involvement was detected during restaging, vs those showing symptomatic brain metastases during the follow-up.
Only 4 patients had asymptomatic metastases, diagnosed with the restaging brain CT scan. Their survival rate was significantly lower than that of the 20 patients whose brain involvement was shown by a follow-up CT scan, performed after the onset of neurological symptoms. However, death was rarely a consequence of brain metastases: primary or other metastatic sites were involved in the terminal events, in the greatest majority of these cases.
The sudden, asymptomatic brain involvement, detected at restaging CT scan after primary therapy for unresectable lung cancer, does not correlate with a better prognosis than symptomatic metastases, diagnosed later with a follow-up CT obtained performed for clinical suspicion. Therefore the use of restaging CT scan is not warranted, as a routine procedure, except for the clinical trials intended to define optimal treatment schedules.
评估CT脑部扫描在不可切除肺癌的初次、积极、药物或放射治疗后作为常规再分期检查的作用。如果能检测到早期无症状脑转移并进行治疗，相对于那些在随访期间、出现神经症状时进行的后续CT扫描中显示有脑转移的患者，生存期可能会得到改善。
100例因组织学类型（小细胞癌）或晚期（III、IV期）而无法切除的肺癌患者，在进行包括脑部CT在内的临床分期（所有患者脑部CT均为阴性）后，接受了化疗和/或放疗。在治疗结束时（再分期），在没有任何神经症状的情况下，再次进行脑部CT检查。仅在后续随访期间出现提示脑转移的临床症状时，才进行进一步扫描。对在再分期时检测到脑转移的患者与在随访期间出现症状性脑转移的患者的生存值进行了分析。
只有4例患者通过再分期脑部CT扫描诊断为无症状转移。他们的生存率明显低于20例在出现神经症状后进行的随访CT扫描显示有脑转移的患者。然而，死亡很少是脑转移的结果：在这些病例中的绝大多数情况下，终末期事件涉及原发性或其他转移部位。
在不可切除肺癌的初次治疗后，在再分期CT扫描中检测到的突发、无症状脑转移，与后期因临床怀疑而进行的随访CT扫描诊断出的症状性转移相比，预后并无改善。因此，除了旨在确定最佳治疗方案的临床试验外，作为常规程序，不建议使用再分期CT扫描。
