Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission
Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission
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DOI：
10.1056/nejm199908123410703
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发表时间：
1999-08-12
影响因子：
158.5
通讯作者：
Aisner, J
中科院分区：
文献类型：
--
作者：
Aupérin, A;Arriagada, R;Aisner, J
背景：预防性脑照射可降低小细胞肺癌患者脑转移的发生率。对于完全缓解的患者，这种治疗是否能提高生存率尚不清楚。我们进行了荟萃分析，以确定是否预防性颅照射survival.Methods我们分析了987例小细胞肺癌患者的个人资料，在完全缓解谁参加了7项试验，比较预防性颅照射，没有预防性颅照射。结果治疗组与对照组相比死亡的相对危险度为0.84（95%可信区间0.73 ~ 0.97; P = 0.01），相当于3年生存率增加5.4%（对照组为15.3%，治疗组为20.7%）。预防性头颅照射还增加了无病生存率（复发或死亡的相对风险，0.75; 95%置信区间，0.65 ~ 0.86; P < 0.001），并降低了脑转移的累积发生率（相对风险，0.46; 95%置信区间，0.38 ~ 0.57; P < 0.001）。根据对四种总剂量（8戈伊、24 - 25戈伊、30戈伊和36 - 40戈伊）的分析，更大剂量的放射导致脑转移风险的更大降低（趋势P = 0.02），但对生存的影响并不因剂量而异。我们还确定了一个趋势（P = 0.01），减少脑转移的风险与早期管理的颅照射后，开始诱导chemotherapy.Conclusions预防性颅照射提高了总生存率和无病生存的小细胞肺癌患者在完全缓解，（N Engl J Med 1999;341：476-84。）(C)1999年马萨诸塞州医学会。
Background Prophylactic cranial irradiation reduces the incidence of brain metastasis in patients with small-cell lung cancer. Whether this treatment, when given to patients in complete remission, improves survival is not known. We performed a metaanalysis to determine whether prophylactic cranial irradiation prolongs survival.Methods We analyzed individual data on 987 patients with small-cell lung cancer in complete remission who took part in seven trials that compared prophylactic cranial irradiation with no prophylactic cranial irradiation. The main end point was survival.Results The relative risk of death in the treatment group as compared with the control group was 0.84 (95 percent confidence interval, 0.73 to 0.97; P = 0.01), which corresponds to a 5.4 percent increase in the rate of survival at three years (15.3 percent in the control group vs. 20.7 percent in the treatment group). Prophylactic cranial irradiation also increased the rate of disease-free survival (relative risk of recurrence or death, 0.75; 95 percent confidence interval, 0.65 to 0.86; P < 0.001) and decreased the cumulative incidence of brain metastasis (relative risk, 0.46; 95 percent confidence interval, 0.38 to 0.57; P < 0.001). Larger doses of radiation led to greater decreases in the risk of brain metastasis, according to an analysis of four total doses (8 Gy, 24 to 25 Gy, 30 Gy, and 36 to 40 Gy) (P for trend = 0.02), but the effect on survival did not differ significantly according to the dose. We also identified a trend (P = 0.01) toward a decrease in the risk of brain metastasis with earlier administration of cranial irradiation after the initiation of induction chemotherapy.Conclusions Prophylactic cranial irradiation improves both overall survival and disease-free survival among patients with small-cell lung cancer in complete remission, (N Engl J Med 1999;341:476-84.) (C) 1999. Massachusetts Medical Society.