Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer Patients: Secondary Findings From the Prospective Randomized Phase 3 CONVERT Trial
Prophylactic Cranial Irradiation for Limited-Stage Small-Cell Lung Cancer Patients: Secondary Findings From the Prospective Randomized Phase 3 CONVERT Trial
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DOI：
10.1016/j.jtho.2018.09.019
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发表时间：
2019-02-01
影响因子：
20.4
通讯作者：
Faivre-Finn, Corinne
中科院分区：
文献类型：
--
作者：
Levy, Antonin;Le Pechoux, Cecile;Faivre-Finn, Corinne
简介：胸部放射治疗的剂量和分割对脑转移（BM）的风险的影响尚未进行前瞻性评估，在有限阶段的小细胞肺癌患者接受预防性脑照射（PCI）。方法：数据从PCI治疗的患者从CONVERT trial.Results：四百四十九547例（82%）接受PCI后完成放化疗。基线脑成像包括449例患者中356例（79%）的计算机断层扫描和449例患者中83例（18%）的磁共振成像。每日两次（BD）组273名参与者中有220名（81%）接受了PCI，每日一次（OD）组270名参与者中有229名（85%; p = 0.49）接受了PCI。BD组和OD组的总中位PCI剂量均为25戈伊（p = 0.74）。在接受PCI的患者中，75例（17%）发生BM（OD组35例[8%]，BD组40例[9%]），173例（39%）发生其他颅外进展。在单变量分析中，大体肿瘤体积（GTV）与BM（p = 0.007）或其他放射学进展事件（p = 0.006）风险增加相关，而在多变量分析中，胸部GTV（tGTV）和ECOG体能评分均与任一进展类型相关。接受PCI治疗的患者的中位总生存期（OS）为29个月。在OS的单因素分析中，化疗结束后的PCI时间，体重减轻超过10%，和tGTV的预后因素与OS。在多因素分析中，只有tGTV与OS。化疗结束和PCI之间的延迟与OS无关。结论：接受OD或BD胸部放疗的患者有相同的风险发展BM。较大的肿瘤与BM的风险较高相关。(C)2018年国际肺癌研究协会。爱思唯尔公司出版All rights reserved.
Introduction: The impact of the dose and fractionation of thoracic radiotherapy on the risk of developing brain metastasis (BM) has not been evaluated prospectively in limited stage SCLC patients receiving prophylactic cerebral irradiation (PCI).Methods: Data from patients treated with PCI from the CONVERT trial were analyzed.Results: Four hundred forty-nine of 547 patients (82%) received PCI after completion of chemoradiotherapy. Baseline brain imaging consisted of computed tomographic scans in 356 of 449 patients (79%) and magnetic resonance imaging in 83 of 449 (18%) patients. PCI was delivered to 220 of 273 participants (81%) in the twice-daily (BD) group and 229 of 270 in the once-daily (OD) group (85%; p = 0.49). Total median PCI dose was 25 Gy in both the BD and OD groups (p = 0.74). In patients who received PCI, 75 (17%) developed BM (35 [8%] in OD and 40 [9%] in BD) and 173 (39%) other extracranial progression. In the univariate analysis, gross tumor volume (GTV) was associated with an increased risk of BM (p = 0.007) or other radiological progression events (p = 0.006), whereas in a multivariate analysis both thoracic GTV (tGTV) and ECOG performance score were associated with either progression type. The median overall survival (OS) of patients treated with PCI was 29 months. In the univariate analysis of OS, PCI timing from end of chemotherapy, weight loss of more than 10%, and tGTV were prognostic factors associated with OS. In the multivariate analysis, only tGTV was associated with OS. Delay between end of chemotherapy and PCI was not associated with OS.Conclusions: Patients receiving OD or BD thoracic radiotherapy have the same risk of developing BM. Larger tumors are associated with a higher risk of BM. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.