全脑放疗对广泛期小细胞肺癌脑转移的生存影响

The impact of whole brain radiation therapy on overall survival in patients with extensive stage small cell lung cancer with brain metastases

目的探索现代诊疗条件下,全脑放疗(WBRT)能否延长小细胞肺癌(SCLC)脑转移患者的生存期。方法回顾性分析天津医科大学肿瘤医院2010—2020年245例伴有脑转移的广泛期SCLC患者的病历资料,其中WBRT组168例(剂量30 Gy分10次),无WBRT组77例。所有患者均接受了至少2个周期的化疗,化疗方案均为顺铂或卡铂联合依托泊苷,115例接受了胸部放疗。研究终点为脑转移后生存期(BM-OS),采用卡方检验对分类数据进行比较,采用稳健逆概率处理加权(sIPTW)方法对组间变量进行匹配,采用Kaplan-Meier方法进行生存分析,log-rank检验进行生存曲线比较。结果全组患者中位BM-OS为9.1个月。有无WBRT患者的中位BM-OS分别为10.6、6.7个月(P=0.003),应用sIPTW平衡两组影响因素后,两组的BM-OS差异仍具有统计学意义(P=0.02)。其中,首诊广泛期伴脑转移患者118例,有无WBRT的中位BM-OS分别为13.0、9.6个月(P=0.007);广泛期疗中出现脑转移患者127例,有无WBRT的中位BM-OS分别为8.0、4.1个月(P=0.003)。在50例单纯脑转移患者中,有无WBRT的中位BM-OS为13.3、10.9个月(P=0.259);在195例伴有颅外转移的患者中,有无WBRT的中位BM-OS分别为9.5、5.9个月(P=0.009)。结论广泛期小细胞肺癌脑转移患者行全脑放疗能够为患者带来生存获益。

Objective To evaluate whether whole brain radiation therapy(WBRT)could benefit small cell lung cancer(SCLC)patients with brain metastases.Methods Clinical data of 245 patients who were diagnosed with extensive stage SCLC with brain metastases admitted to our hospital from 2010 to 2020 were retrospectively analyzed.Among them,168 patients received WRBT(WBRT group,radiation dose:30Gy in 10 fractions),and 77 patients did not receive WBRT(non-WBRT group).All patients received 4-6 cycles of chemotherapy,and the chemotherapy regimen included cisplatin(or carboplatin)plus etoposide.One hundred and fifteen patients received thoracic radiotherapy.The endpoint was overall survival after brain metastases(BM-OS).Chi-square test was used to compare categorical data,and stabilized inverse probability of treatment weighting(sIPTW)was used to match the factors between WBRT and no-WBRT groups.Survival analysis was estimated by Kaplan-Meier method,and the log-rank test was used to compare survival curves between two groups.Results The median BM-OS for the whole group of patients was 9.1 months,and 10.6 months and 6.7 months in the WBRT and non-WBRT groups,respectively(P=0.003).After balanced influencing factors with stabilized sIPTW,significant difference still existed in BM-OS between two groups(P=0.02).In 118 patients with synchronous brain metastases,the median BM-OS in two groups were 13.0 months and 9.6 months(P=0.007);and in 127 patients with metachronous brain metastases,the median BM-OS were 8.0 months and 4.1 months(P=0.003).In 50 patients without extracranial metastases,the median BM-OS were 13.3 months and 10.9 months(P=0.259)in two groups;while in 195 patients with extracranial metastases,the median BM-OS were 9.5 months and 5.9 months(P=0.009)in two groups.Conclusions WBRT could prolong the OS in extensive stage SCLC patients with brain metastases.