局部增量照射无益于全脑照射SCLC脑转移患者生存再提高

摘要

Objective To investigate the effect of radiation boost ( Boost ) on further improving overall survival ( OS) and intracranial progression-free survival ( IPFS) of small-cell lung cancer ( SCLC) brain metastases (BM) patients treated by whole-brain radiotherapy (WBRT). Methods A retrospective analysis of 142 consecutive SCLC BM patients admitted between 2013 and 2015 was conducted after excluding those with historical prophylactic cranial irradiation (n=16) or SRT (n=10) or local RT alone (n=1).The Kaplan-Meier curve was utilized to calculate the survival rate. The log-rank test and multivariate Cox proportional hazard regression model were utilized to evaluate clinical prognosis. Results All patients were aged 59. 6 years old on average, and the female proportion was 23％. The quantity of brain metastasis lesion was 1 in 35％, 2-3 in 23％ and ≥4 in 42％, respectively. The proportion of patients receiving chemotherapy was 70％. The median OS was 9. 0 months and the median IPFS was 7. 3 months. The accumulative mortality rate in the non-radiation ( n=53 ) , WBRT ( n=33 ) and WBRT+ Boost ( n=56 ) groups was 92％, 79％ and 73％, and the accumulative failure rate ( death or new/relapsed brain metastasis) was 94％, 82％ and 80％, respectively. Compared with the non-radiation group, WBRT and WBRT+Boost therapies exerted significant effect upon OS ( P=0. 000 and 0. 000) and IPFS ( P=0. 000 and 0. 000) . Compared with WBRT alone, WBRT+ Boost treatment exerted no significant effect upon OS ( P=0. 41 and 0. 51) . Conclusions WBRT can significantly improve OS and IPFS of patients with SCLC-BM. However, concurrent and additional radiation boost does not further improve the survival rate.%目的 探讨局部增量照射(Boost)能否提高WBRT对小细胞肺癌脑转移(SCLC-BM)患者的OS和无颅内进展生存.方法 回顾分析2013—2015年首次诊治SCLC-BM 166例.除外PCI史(16例)或SRT(10例)或单纯局部脑照射(1例),入组142例.利用Kaplan-Meier法计算生存率Logrank法检验和单因素预后分析,Cox模型多因素预后分析.结果 平均年龄59.6岁,女性23％,脑转移灶数目分别为1(35％)、2～3(23％)、≥4(42％),化疗70％.中位OS期9.0个月、无颅内进展生存7.3个月.无照射(53例)、单纯WBRT(33)和WBRT+Boost(56)累计死亡率依次为92％、79％和73％;累计失败(死亡或颅内病灶未控)率为94％、82％和80％;与无照射相比,以上放疗模式对OS有影响(P=0.000、0.000),无颅内进展生存也有影响(P=0.000、0.000).与单纯WBRT相比,WBRT+Boost对OS无影响(P=0.41、0.51).结论 WBRT提高SCLC脑转移患者OS和无颅内进展生存,但同期或后续Boost照射无益于再提高生存.