小细胞肺癌脑转移不同颅内放疗模式的生存分析

Survival of patients with brain metastases from small cell lung cancer under different intracranial radiotherapy modalities

目的探讨不同颅内放疗模式在小细胞肺癌脑转移(SCLC-BM)有限个数(≤10个)中的预后影响。方法分析2019-2022年于蚌埠医科大学第一附属医院接受颅内放疗的143例SCLC-BM患者资料,根据放疗模式分为全脑放疗组(WBRT,58例)、WBRT联合同步加量放疗组(WBRT+SIB,53例)及WBRT联合序贯加量放疗组(WBRT+SEB,32例)。采用Kaplan-Meier法计算总生存期(OS)、颅内无进展生存期(IPFS),Cox模型行预后分析。结果全组患者中位OS、中位IPFS为11.9、9.9个月;1、2、3年生存率为49.7%、15.3%、2.9%。WBRT+SIB、WBRT+SEB及WBRT组患者OS差异无统计学意义(中位OS:13.0、12.5、11.2个月,P>0.05)。WBRT+SIB及WBRT+SEB组在IPFS方面优于WBRT组(中位IPFS:11.7、10.4、8.1个月,χ^(2)=21.69,P<0.001)。对少发脑转移(≤3个)患者单独分析,WBRT+SIB及WBRT+SEB组在OS及IPFS方面均优于WBRT组(中位OS:14.4、13.7、11.5个月,χ^(2)=8.72,P=0.013;中位IPFS:12.6、10.4、8.9个月,χ^(2)=12.37,P=0.002)。评价中枢神经系统以及血液学急性放射性反应达到2级及以上的程度在3组间的差异显示无统计学意义(P>0.05)。全组患者多因素分析显示,后续化疗、靶向及免疫治疗是患者OS和IPFS共同的独立影响因素。体质量指数(BMI)水平是患者OS的独立影响因素,脑转移数目、淋巴结转移以及放疗模式的选择是患者IPFS的独立影响因素。结论BMI水平、后续化疗、靶向治疗及免疫治疗是患者预后的独立影响因素。WBRT+SIB及WBRT+SEB放疗模式有望提高患者的IPFS。

ObjectiveTo explore the prognostic impact of different intracranial radiotherapy modalities in patients with a limited number(≤10)of brain metastases from small cell lung cancer(SCLC-BM).MethodsThe data of 143 cases with SCLC-BM that received intracranial radiotherapy at the First Affiliated Hospital of Bengbu Medical University in 2019-2022 were analyzed.The patients were grouped by radiotherapy modalities:whole brain radiotherapy(WBRT,58 cases),WBRT combined with simultaneous integrated boost(WBRT+SIB,53 cases),and WBRT combined with sequential integrated boost(WBRT+SEB,32 cases).The overall survival(OS)and intracranial progression-free survival(IPFS)were calculated using the Kaplan-Meier method,and the Cox proportional hazard model was used for prognostic analysis.ResultsIn the whole group,the median OS and IPFS were 11.9 and 9.9 months,and the 1-,2-,and 3-year survival rates were 49.7%,15.3%,and 2.9%,respectively.The difference in OS among patients in the WBRT+SIB,WBRT+SEB,and WBRT groups was not significant(median OS:13.0 months vs.12.5 months vs.11.2 months,P>0.05).The WBRT+SIB and WBRT+SEB groups were preferred over the WBRT group in terms of IPFS(median IPFS:11.7 months vs.10.4 months vs.8.1 months,χ^(2)=21.69,P<0.001).For patients with few brain metastases(≤3)analyzed separately,the WBRT+SIB and WBRT+SEB groups were preferred over the WBRT group in terms of OS and IPFS(median OS:14.4 months vs.13.7 months vs.11.5 months,χ^(2)=8.72,P=0.013;median IPFS:12.6 months vs.10.4 months vs.8.9 months,χ^(2)=12.37,P=0.002).Evaluation of the central nervous system as well as hematological acute radiological reactions reaching grade 2 and above showed no significant differences among the three groups(P>0.05).Multivariate analysis showed that subsequent chemotherapy,targeted therapy,and immunotherapy were common independent influencing factors for patients′OS and IPFS.Body mass index(BMI)level was an independent influencing factor for patients′OS,and the number of brain metastases,lymph node metastasis,and radiotherapy modality were independent influencing factors for patients′IPFS.ConclusionsBMI level and subsequent treatment(chemotherapy,targeted therapy,and immunotherapy)are independent influencing factors for patients'prognosis.WBRT+SIB and WBRT+SEB modalities are associated with increased IPFS.