Prophylactic cranial irradiation for limited-stage small-cell lung cancer in the magnetic resonance imaging era.
Prophylactic cranial irradiation for limited-stage small-cell lung cancer in the magnetic resonance imaging era.
复制标题
磁共振成像时代对局限期小细胞肺癌进行预防性颅脑照射
作者：
我们根据磁共振成像（MRI）时代的肿瘤反应，研究了预防性颅照射（PCI）在局限期小细胞肺癌（LS-SCLC）中的作用。我们回顾性评价了2006年至2017年在我们中心进行初始放化疗后获得完全缓解（CR）或部分缓解（PR）的MRI检查无脑转移（BM）的LS‐SCLC患者。本研究包括116例患者（中位年龄58岁;男性92例;女性24例）。初始放化疗后，53例患者达到CR，63例患者达到PR。83例患者接受PCI。接受PCI的患者的总生存率（OS，5年：52.5% vs. 35.1%; p = 0.012）和无进展生存率（PFS，5年：45.0% vs. 28.2%; p = 0.001）更高，BM发生率更低（5年：18.3% vs. 39.4%; p = 0.010）。在亚组分析中，PCI改善了CR患者的OS（5年：67.8% vs. 46.7%，p = 0.005）和PFS（5年：65.2% vs. 35.0%，p = 0.021），并降低了BM风险（5年：12.1% vs. 52.4%，p = 0.002）。然而，对于PR患者，PCI没有获益（5年OS：40.5% vs. 35.6%，p = 0.763; 5年BM：24.6% vs. 31.9%，p = 0.561）。在MRI时代，肿瘤缓解仍然是选择PCI患者的重要因素。对于初次胸部放化疗后达到CR的LS‐SCLC患者，应推荐PCI。在磁共振成像时代，肿瘤缓解仍然是选择局限期小细胞肺癌患者接受预防性颅照射（PCI）的重要因素。对于初次胸部放疗后完全缓解的患者，仍应考虑PCI。
We investigated the role of prophylactic cranial irradiation (PCI) in limited‐stage small‐cell lung cancer (LS‐SCLC) according to tumor response in the magnetic resonance imaging (MRI) era. We retrospectively evaluated patients with LS‐SCLC without brain metastases (BMs) on MRI who achieved either complete response (CR) or partial response (PR) after initial chemoradiotherapy at our center from 2006 to 2017. This study comprised 116 patients (median age, 58 years; men, 92; women, 24). After initial chemoradiotherapy, 53 patients achieved CR, while 63 patients achieved PR. Eighty‐three patients received PCI. Patients who received PCI had better overall survival (OS, 5‐year: 52.5% vs. 35.1%; p = 0.012) and progression‐free survival (PFS, 5‐year: 45.0% vs. 28.2%; p = 0.001) and a lower incidence of BMs (5‐year: 18.3% vs. 39.4%; p = 0.010). In the subgroup analysis, PCI improved OS (5‐year: 67.8% vs. 46.7%, p = 0.005) and PFS (5‐year: 65.2% vs. 35.0%, p = 0.021) and decreased BM risk (5‐year: 12.1% vs. 52.4%, p = 0.002) for patients with CR. However, PCI had no benefit (5‐year OS: 40.5% vs. 35.6%, p = 0.763; 5‐year BMs: 24.6% vs. 31.9%, p = 0.561) for patients with PR. Tumor response remained an important factor for selecting patients for PCI in the MRI era. PCI should be recommended for patients with LS‐SCLC who achieve CR after initial thoracic chemoradiotherapy. Tumor response remains an important factor for selecting patients with limited‐stage small‐cell lung cancer for prophylactic cranial irradiation (PCI) in the magnetic resonance imaging era. PCI should still be considered for patients with complete response after initial thoracic radiotherapy.