■关于小细胞肺癌(SCLC)患者预防性颅骨照射(PCI)的益处引起了争议,特别是自2017年Takahashi试验发表以来,该试验支持广泛阶段(ES-)SCLC的MRI监测。这项研究的主要目的是评估2010-2018年PCI使用的趋势和决定因素。次要目标是确定放射肿瘤学家(RO)的当代实践考虑因素。
■使用荷兰癌症登记数据对所有新诊断的SCLC患者(2010-2018)进行了一项基于人群的全国性队列研究。使用逻辑回归模型分析了多年来PCI频率的变化和PCI的决定因素。第二,2020年对荷兰肺癌RO进行了一项在线调查。
■在10264名符合条件的患者中,4894(47%)接受PCI。与2010-2014年相比,2017-2018年ES-SCLC(OR0.68,95CI0.60-0.77)和LS-SCLC(OR0.56,95CI0.47-0.67)的PCI使用率显着下降。发病年份,年龄,性能状态,和胸部放疗是PCI的独立决定因素。在41名调查参与者中,在ES-SCLC中,始终/有时/从不推荐PCI的比例分别为22%/71%/7%和LS-SCLC的54%/44%/2%。对于ES-SCLC和LS-SCLC,63%和25%的RO,分别,确认高桥试验对PCI建议的影响.否认这种影响与机构MRI能力不足有关。
■自2017年以来,荷兰在ES-SCLC和LS-SCLC中的PCI使用呈显著下降趋势。即使在LS-SCLC中,高桥试验也似乎是对这一趋势的解释,试验的不同影响取决于机构MRI能力。发现有关PCI的实践差异惊人地增加,这强调了正在进行的试验的重要性。
UNASSIGNED: Controversy has arisen regarding the benefit of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC), particularly since the 2017 Takahashi
trial publication that supports MRI surveillance in extensive-stage (ES-)SCLC. The primary aim of this
study was to assess trends and determinants in PCI use over the years 2010-2018. A secondary aim was to determine contemporary practice considerations among radiation oncologists (ROs).
UNASSIGNED: A nationwide population-based cohort
study was conducted using the Netherlands Cancer Registry data on all newly diagnosed SCLC patients (2010-2018). The change in PCI frequency over the years and determinants for PCI were analyzed using logistic regression models. Second, an online survey was performed among Dutch lung cancer ROs in 2020.
UNASSIGNED: Among 10,264 eligible patients, 4,894 (47%) received PCI. Compared to 2010-2014, PCI use significantly decreased in 2017-2018 in ES-SCLC (OR 0.68, 95%CI 0.60-0.77) and LS-SCLC (OR 0.56, 95%CI 0.47-0.67). Incidence year, age, performance status, and thoracic radiotherapy were independent determinants for PCI. Among 41 survey participants, PCI was recommended always/sometimes/never by 22%/71%/7% in ES-SCLC and 54%/44%/2% in LS-SCLC. For ES-SCLC and LS-SCLC, 63% and 25% of ROs, respectively, confirmed influence of the Takahashi
trial on PCI recommendations. Denial of such influence was associated with insufficient institutional MRI capacity.
UNASSIGNED: A significant declining trend of PCI use in both ES-SCLC and LS-SCLC was observed in The Netherlands since 2017. The Takahashi trial seems an explanation for this trend even in LS-SCLC, with differential influence of the
trial depending on institutional MRI capacity. An alarming increase in practice variation regarding PCI was found which stresses the importance of ongoing trials.