PDF(Pubmed)
Abstract：
Prophylactic cranial irradiation (PCI) is considered an important technological advance made in oncology in an effort to reduce the incidence of brain metastases (BM) and improve overall survival (OS) of patients with small cell lung cancer (SCLC). Although it is often reported that PCI improves the therapeutic potential in limited-stage (LS) SCLC, no randomised trial has ever conclusively confirmed this. Nevertheless, PCI has been considered the standard of care for LS-SCLC since the late 1990s. The data supporting the use of PCI in LS-SCLC are based on an analysis of work performed prior to the current approach to staging [brain magnetic resonance imaging (MRI), positron emission tomography (PET)/computed tomography (CT)]. The evidence for the rationale and feasibility of this approach in the modern diagnostic era should be demonstrated. The situation with extensive stage (ES) SCLC is seemingly easier because, unlike LS-SCLC, we have data from two randomised trials. Unfortunately, their results are in direct conflict with each other. Although it is generally assumed that good control of brain disease leads to better quality of life, this has never been prospectively demonstrated. In fact, PCI is associated not only with increased treatment costs and some patient discomfort, but also with non-negligible potential toxicity. For this reason, efforts have been made to preserve cognitive function by sparing the hippocampus. This concept is called hippocampal avoidance. The optimal fractionation regimen is currently less controversial than the optimal integration of PCI into the treatment algorithm. A dose of 25 Gy administered in 10 fractions should remain the standard for the eventual use of PCI in patients with SCLC. In summary, PCI is not a conditio sine qua non in any indication. Neither in patients with LS-SCLC nor in patients with ES-SCLC has a clear improvement in OS been demonstrated at follow-up using current imaging modalities.
摘要：
预防性颅骨照射（PCI）被认为是肿瘤学中一项重要的技术进步，旨在降低小细胞肺癌（SCLC）患者的脑转移（BM）的发生率并提高其总体生存率（OS）。尽管经常报道PCI改善了有限阶段（LS）SCLC的治疗潜力，没有一项随机试验确证这一点.然而，自1990年代后期以来，PCI一直被认为是LS-SCLC的护理标准。支持在LS-SCLC中使用PCI的数据基于对当前分期方法[脑磁共振成像（MRI），正电子发射断层扫描（PET）/计算机断层扫描（CT）]。应该证明这种方法在现代诊断时代的合理性和可行性的证据。广泛阶段(ES)SCLC的情况似乎更容易，因为，与LS-SCLC不同，我们有两项随机试验的数据.不幸的是,他们的结果彼此直接冲突。尽管人们普遍认为，良好的脑部疾病控制会带来更好的生活质量，这一点从未得到前瞻性的证明。事实上,PCI不仅与增加的治疗成本和一些患者的不适相关，但也具有不可忽视的潜在毒性。出于这个原因,已经努力通过保留海马来保持认知功能。这个概念被称为海马回避。目前，与将PCI最佳集成到治疗算法中相比，最佳分割方案的争议较小。在SCLC患者中，25Gy的剂量应保持最终使用PCI的标准。总之,PCI不是任何适应症的必要条件。在LS-SCLC患者和ES-SCLC患者中，使用当前的成像方式进行随访时，OS均未明显改善。
