磁共振成像监测时代脑预防照射在局限期小细胞肺癌中的价值  

Value of prophylactic cranial irradiation for limited stage small cell lung cancer in the era with magnetic resonance imaging surveillance

作　　者：张瑞[1] 乔学英[1] 景仲昊 宋玉芝[1] 王硕烁 李静[1] ZHANG Rui;QIAO Xueying;JING Zhonghao;SONG Yuzhi;WANG Shuoshuo;LI Jing(Department of Radiotherapy,Fourth Hospital of Hebei Medical University,Shijiazhuang 05o0ll,China)

机构地区：[1]河北医科大学第四医院放疗科,河北石家庄050011

出　　处：《中华肿瘤防治杂志》2023年第3期154-160,共7页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的 探讨磁共振成像(MRI)时代局限期小细胞肺癌(LS-SCLC)根治性放化疗后疗效评价达完全缓解(CR)或部分缓解(PR)者,行全脑预防性照射(PCI)的疗效及脑转移危险因素分析。方法 回顾性分析2013-07-01-2017-06-30在河北医科大学第四医院行根治性放化疗的177例LS-SCLC患者病历资料。根据是否行PCI分为PCI组(77例)和非PCI组(100例)。所有患者均行颅脑增强MRI监测随访,发生脑转移后行挽救性治疗。分析比较2组患者的生存预后情况。采用Kaplan-Meier法行生存分析,Cox模型多因素行预后分析。结果 PCI组和非PCI组的1、2、3年总生存率(OS)分别为95.9%、70.3%、51.5%和90.9%、44.4%、25.1%,χ^(2)=13.547,P<0.001;无脑转移生存率(BMFS)分别为97.1%、76.8%、70.5%和68.9%、53.6%、46.9%,χ^(2)=19.284,P<0.001。多因素分析显示,PCI(HR=0.497,95%CI:0.300~0.825,P=0.007)及初始治疗疗效CR(HR=3.142,95%CI:1.722~5.730,P<0.001)是OS的独立保护因素,同样PCI(HR=0.338,95%CI:0.181~0.631,P=0.001)及初始治疗疗效CR(HR=3.078,95%CI:1.473~6.431,P=0.003)也是BMFS的独立保护因素。结论 在MRI时代,LS-SCLC根治性放化疗后行PCI仍可获益,优势人群有待进一步探索。Objective To evaluate the clinical efficacy and the risk factors of brain metastasis of prophylactic cranial irradiation(PCI) for the patients with limited-stage small cell lung cancer(LS-SCLC) who achieved complete response(CR) or partial response(PR) after definitive chemoradiotherapy in the era of magnetic resonance imaging(MRI).Methods From July 1,2013 to June 30,2017,177 patients with LS-SCLC who were treated with definitive chemoradiotherapy at the Fourth Hospital of Hebei Medical University were analyzed in this retrospective study.They were divided into the PCI group(n=77) and non-PCI group(n=100).All patients were followed up with brain enhancement MRI surveillance, and salvage treatment was conducted after brain metastasis.The survival between PCI group and non-PCI group was analyzed and compared.The survival analysis was performed by Kaplan-Meier method.Multivariate prognostic analysis was conducted by Cox models.Results The 1-year, 2-year and 3-year overall survival(OS) rates were 95.9%,70.3%,51.5% in PCI group versus 90.9%,44.4%,25.1% in non-PCI group, χ^(2)=13.547,P<0.001.The 1-year, 2-year and 3-year brain metastasis free survival(BMFS) were 97.1%,76.8%,70.5% in PCI group versus 68.9%,53.6%,46.9% in non-PCI group, χ^(2)=19.284,P<0.001.Multivariate analysis showed that PCI(HR=0.497,95%CI:0.300-0.825,P=0.007),and CR at initial treatment(HR=3.142,95%CI:1.722-5.730,P<0.001) were the favorable independent prognostic factors of OS.PCI(HR=0.338,95%CI:0.181-0.631,P=0.001) and CR(HR=3.078,95%CI:1.473-6.431,P=0.003) were also the favorable independent prognostic factors for BMFS.Conclusions In the modern era of MRI,PCI confers better survival than non-PCI for LS-SCLC patients after definitive chemoradiotherapy.The dominant population for PCI needs to be further explored.

关 键 词：局限期小细胞肺癌 放化疗 脑预防性照射 脑转移 预后 

分 类 号：R734.2[医药卫生—肿瘤]