PDF(Pubmed)
Abstract：
OBJECTIVE: In the context of the widespread availability of magnetic resonance imaging (MRI) and aggressive salvage irradiation techniques, there has been controversy surrounding the use of prophylactic cranial irradiation (PCI) for small-cell lung cancer (SCLC) patients. This study aimed to explore whether regular brain MRI plus salvage brain irradiation (SBI) is not inferior to PCI in patients with limited-stage SCLC (LS-SCLC).
METHODS: This real-world multicenter study, which was conducted between January 2014 and September 2020 at three general hospitals, involved patients with LS-SCLC who had a good response to initial chemoradiotherapy and no brain metastasis confirmed by MRI. Overall survival (OS) was compared between patients who did not receive PCI for various reasons but chose regular MRI surveillance and followed salvage brain irradiation (SBI) when brain metastasis was detected and patients who received PCI.
RESULTS: 120 patients met the inclusion criteria. 55 patients received regular brain MRI plus SBI (SBI group) and 65 patients received PCI (PCI group). There was no statistically significant difference in median OS between the two groups (27.14 versus 33.00 months; P = 0.18). In the SBI group, 32 patients underwent whole brain radiotherapy and 23 patients underwent whole brain radiotherapy + simultaneous integrated boost. On multivariate analysis, only extracranial metastasis was independently associated with poor OS in the SBI group.
CONCLUSIONS: The results of this real-world study showed that MRI surveillance plus SBI is not inferior to PCI in OS for LS-SCLC patients who had a good response to initial chemoradiotherapy.
METHODS: This real-world multicenter study, which was conducted between January 2014 and September 2020 at three general hospitals, involved patients with LS-SCLC who had a good response to initial chemoradiotherapy and no brain metastasis confirmed by MRI. Overall survival (OS) was compared between patients who did not receive PCI for various reasons but chose regular MRI surveillance and followed salvage brain irradiation (SBI) when brain metastasis was detected and patients who received PCI.
RESULTS: 120 patients met the inclusion criteria. 55 patients received regular brain MRI plus SBI (SBI group) and 65 patients received PCI (PCI group). There was no statistically significant difference in median OS between the two groups (27.14 versus 33.00 months; P = 0.18). In the SBI group, 32 patients underwent whole brain radiotherapy and 23 patients underwent whole brain radiotherapy + simultaneous integrated boost. On multivariate analysis, only extracranial metastasis was independently associated with poor OS in the SBI group.
CONCLUSIONS: The results of this real-world study showed that MRI surveillance plus SBI is not inferior to PCI in OS for LS-SCLC patients who had a good response to initial chemoradiotherapy.
摘要：
目的：在磁共振成像（MRI）和积极抢救辐照技术广泛使用的背景下，对于小细胞肺癌(SCLC)患者使用预防性颅骨照射(PCI)一直存在争议.这项研究旨在探讨在有限期SCLC（LS-SCLC）患者中，常规脑MRI加抢救脑照射（SBI）是否不亚于PCI。
方法：这项真实世界的多中心研究，2014年1月至2020年9月在三家综合医院进行，纳入的LS-SCLC患者对初始放化疗反应良好,MRI证实无脑转移.比较了由于各种原因未接受PCI但选择定期MRI监测并在检测到脑转移时进行抢救脑照射（SBI）的患者与接受PCI的患者之间的总生存期（OS）。
结果：120例患者符合纳入标准。55例患者接受常规脑MRI+SBI（SBI组），65例患者接受PCI（PCI组）。两组的中位OS差异无统计学意义（27.14和33.00个月；P=0.18）。在SBI小组中，32例患者接受了全脑放疗，23例患者接受了全脑放疗+同时综合加强。在多变量分析中，SBI组只有颅外转移与不良OS独立相关.
结论：这项现实世界研究的结果表明，对于对初始放化疗有良好反应的LS-SCLC患者，MRI监测加SBI在OS方面并不劣于PCI。
方法：这项真实世界的多中心研究，2014年1月至2020年9月在三家综合医院进行，纳入的LS-SCLC患者对初始放化疗反应良好,MRI证实无脑转移.比较了由于各种原因未接受PCI但选择定期MRI监测并在检测到脑转移时进行抢救脑照射（SBI）的患者与接受PCI的患者之间的总生存期（OS）。
结果：120例患者符合纳入标准。55例患者接受常规脑MRI+SBI（SBI组），65例患者接受PCI（PCI组）。两组的中位OS差异无统计学意义（27.14和33.00个月；P=0.18）。在SBI小组中，32例患者接受了全脑放疗，23例患者接受了全脑放疗+同时综合加强。在多变量分析中，SBI组只有颅外转移与不良OS独立相关.
结论：这项现实世界研究的结果表明，对于对初始放化疗有良好反应的LS-SCLC患者，MRI监测加SBI在OS方面并不劣于PCI。
