文獻匯總

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part1 SCLC-PCI

• LD-SCLC PCI

  • 文獻：Limited-stage small cell lung cancer： is prophylactic cranial irradiation necessary

  • 結(jié)論 PCI能改善PFS，CR病人從PCI獲益少

  • 文獻：is prophylactic cranial irradiation useful in real world

  • PCI在降低腦轉(zhuǎn)移發(fā)生率上效果顯著

  • 文獻：factors affecting the risk of brain metastasis in limited-stage small cell lung cancer after prophylactic cranial irradiation

  • 結(jié)論：腫瘤≥5cm，病例III期患者行PCI后腦轉(zhuǎn)移幾率增加

  • 文獻：reduction in whole brain volume is associated with decline in verbal memory following prophylactic cranial irradiation for limited-stage small-cell lung cancer

  • 首次證實PCI過程中，大腦體積的縮小與認(rèn)知障礙下降有關(guān)，但更需要進一步的研究證實

  • MR imaging evaluation before prophylactic cranial irradiation in limited stage small cell lung cancer： prophylactic or therapeutic？

  • 結(jié)果：對于LD-SCLC，應(yīng)高度重視PCI前腦轉(zhuǎn)移的發(fā)生，尤其是對無癥狀腦轉(zhuǎn)移。腦轉(zhuǎn)移灶可能很小，無法經(jīng)CT檢查發(fā)現(xiàn)。PCI前應(yīng)該行MRI檢查排除腦轉(zhuǎn)移

• ED-SCLC PCI

  • 文獻：nationwide shift in patterns of prophylactic cranial irradiation utilization for extensive-stage small cell lung cancer patients

  • 結(jié)論：Takahashi研究使美國放療醫(yī)生對ED-SCLC患者PCI的使用率顯著下降；參與調(diào)研者期待SCLC患者主動MRI監(jiān)測對比PCI的RCT研究

  • 文獻 prophylactic cranial irradiation in stage IV small cell lung cancer：selection of patients amongst European IASLC and ESTRO experts

  • 結(jié)論：放射腫瘤專家建議應(yīng)用PCI因素：病人的身體狀況好，年輕，化療反應(yīng)好（CR/PR）

  • 文獻 risk stratification of symptomatic brain metastases by clinical and FDG PET parameters for the selective use of prophylactic cranial irradiation in patients with extensive disease of small cell lung cancer

  • 結(jié)論：PCI營選擇性應(yīng)用于癥狀性腦轉(zhuǎn)移高風(fēng)險的患者

    • 對于有四種癥狀性腦轉(zhuǎn)移危險因素：胸外轉(zhuǎn)移灶、FDG PET顯示骨髓或脾高代謝、化療后疾病進展、血紅蛋白升高，PCI改善無腦轉(zhuǎn)移生存，但是未改善OS

  • 文獻 redefining the role of prophylactic cranial irradiation in the modern erra of active surveillance in small cell lung cancer

    • 定義
      • PCI主要目的所示顯著降低癥狀性或隱匿性腦轉(zhuǎn)移的發(fā)生
      • PCI人群的再定義：發(fā)生腦轉(zhuǎn)移風(fēng)險持續(xù)性增加，最終能從PCI獲益的人群

      • 建議

        • LD-SCLC：PCI應(yīng)當(dāng)仍是LD-SCLC（T1-4,N0-3）的標(biāo)準(zhǔn)治療方式
        • ED-SCLC：尚存在爭議，積極的MRI監(jiān)測可考慮。初始治療前后MRI應(yīng)當(dāng)每3個月監(jiān)測一次并持續(xù)至少1年

• SCLC-PCI海馬保護

  • 文獻：phase III trial of prophylactic cranial irradiation with or without Hippocampal avoidance for SMALL-CELL LUNG Cancer

  • HA-PCI有利于維持神經(jīng)認(rèn)知功能，但對OS ，治療毒性，腦轉(zhuǎn)移發(fā)生率無影響

  • 文獻：the incidence and location of brain metastases following HA-PCI compared with standard PCI in small cell lung cancer（SCLC）：a phase III trial

    • 結(jié)論：標(biāo)準(zhǔn)PCI和HA-PCI在腦轉(zhuǎn)移發(fā)生率方面無明顯差別

• part3 SCLC腦轉(zhuǎn)移-SRS

  • 文獻 upfront stereotactic radiosurgery in patients with brain metastases from small cell lung cancer

    • 結(jié)論 SRS可作為SCLC腦轉(zhuǎn)移的一種治療方案，可減少腦損傷

  • 文獻 stereotactic radiosurgery for small cell lung cancer brain metastases

    • 結(jié)論 SRS局部失敗率較低，在SCLC腦轉(zhuǎn)移中可優(yōu)先應(yīng)用