预防性全脑照射在小细胞肺癌综合治疗中的价值

APPRAISAL OF THE ROLE OF PROPHYLACTIC CRANIAL IRRADIATION IN MULTIMODALITY MANAGEMENT FOR SMALL CELL LUNG CANCER

回顾分析了 31例病人接受预防性全脑照射 (PCI)的资料。在诱导化疗和胸部放疗取得完全缓解后 2～ 3月进行PCI。总剂量 4 0Gy2 6例 ,30～ 4 0Gy5例 ,每次照射 1 .8～ 2 0Gy。本组病人 2年生存率 5 1 .9% ( 1 4 /2 7) ,3年生存率 5 2 .4 % ( 1 1 /2 1 ) ,5年生存率 5 0 .0 % ( 5 /1 0 )。PCI后随访中位时间 1 5月( 4～ 74月 ) ,远期神经系统并发症有记忆力下降、头晕乏力、动作迟纯、脑电地形图不正常波型及CT检查轻度脑萎缩等。无 1例发生脑转移。有长期生存希望的小细胞肺癌病人 ,在完全缓解后应作PCI。

The value of prophylactic cranial irradiation (PCI) for small cell lung cancer (SCLC) remains controversial. From Nov.1987 to Jan. 1993, thirty-one patients with small cell lung cancer received PCI. PCI was given for complete remission SCLC patients after chemotherapy and chest radiotherapy. The total dose of PCI was 40Gy in 26 cases, 30～<40Gy in 5 cases with the fractions of 1.8 to 2.0Gy. The 2-,3-,5-year survival rates were 51.9, 52.4 and 50.0, respectively. 10 patients are still alive at present, with a median follow-up period of 15 months (4～47 months). The late complications were memory loss(23%), weakness and psychomotor retardation (29%), abnormal ECG (4/7). Mild atrophy of the brain by CT scan was present in 4/24. All these late complications were mildwithout affecting the life quality. No brain metastasis was found atpresent.These data suggest that PCI be effective to improve the longterm survival of patients who have cotrolled diseases and the neurological complicat ionswere mild. Prospective trials are necessary to evaluate the value of PCI for patients with SCLC.