预防性全脑照射及其不同介入时机对局限期小细胞肺癌预后的影响

Effects of prophylactic cranial irradiation and its different optional times on prognosis of limited-stage small cell lung cancer

目的探究预防性全脑照射(PCI)及其不同介入时机对经基础治疗达完全缓解(CR)的局限期小细胞肺癌(LSCLC)患者预后的影响。方法回顾性分析184例LSCLC患者的临床资料,在基础治疗达CR的前提下以有无PCI干预分为2组,其中PCI组50例(27.2%),非PCI组134例(72.8%);又以是否完成4周期化疗将PCI组分为PCI1组(n=20)和PCI2组(n=30)。基础治疗的化疗方案、照射方式及剂量一致。结果 PCI组、非PCI组脑转移率分别为14.0%、30.6%,差异有统计学意义(P<0.05)。PCI组的中位生存时间及1、2、3年生存率分别为25个月(95%CI:21.487~28.513),54%、36%、15%,而非PCI组为17个月(95%CI:15.175~18.825),37%、18%、13%,2组中位生存时间比较差异有统计学意义(P<0.05)。PCI1组、PCI2组的脑转移率分别为10.0%、16.7%,差异无统计学意义,两亚组间中位生存时间差异亦无统计学意义。结论 PCI可降低LSCLC患者脑转移率、延长总生存时间(OS),而不同介入时机的PCI对LSCLC的预后无明显影响。

Objective To observe the impact of the prophylactic cranial irradiation （PCI） and its different interventional times on the prognosis of patients with limited-stage small cell lung cancer （LSCLC） who received comprehensive therapy of complete response （CR）. Methods A total of 184 LSCLC patients who received radiotherapy and chemotherapy based on comprehensive treatment were retrospectively analyzed. Patients were divided into two groups based on with or without PCI intervention. There were 50 patients （27.2%） in the PCI group and 134 patients （72.8%） in the non PCI group. The PCI group was subdivided into two groups, PCI1 group （n=20） and PCI2 group （n=30）, according to whether patients completed 4 cycles of chemotherapy. Chemotherapy regimen, irradiation method and dose were identical for two groups. Results The brain metastasis rates were 14.0% and 30.6% for PCI group and non PCI group. There was significant difference in brain metastasis rate between the two groups （P〈0.05）. The median survival times were 25 months （95%CI： 21.487-28.513） and 17 months （95%CI： 15.175-18.825） for PCI group and non PCI group （P〈0.05）. The 1,2 and 3-year survival rates were 54%, 36%,15% and 37%,18%,13% for the two groups. There were no significant differences in brain metastasis rates between PCI1 group and PCI2 group （10.0% and 16.7%）. There was no significant difference in median survival time between the two subgroups. Conclusion PCI can reduce the incidence of SCLC brain metastases, and prolong the overall survival time. However, different intervention times of PCI have no significant influence on the prognosis of LSCLC.