Prophylactic Cranial Irradiation Should Be Standard for SCLC Responsive to Chemo
预防性头颅照射应成为化疗反应性小细胞肺癌的标准治疗的一部分
Zosia Chustecka
August 15, 2007 — Prophylactic cranial irradiation should be part of standard care for all patients with small-cell lung cancer (SCLC) who have a response to initial chemotherapy, say researchers reporting a trial showing that this measure significantly reduced the incidence of brain metastases and prolonged disease-free and overall survival.
2007年8月15日——研究者称预防性头颅照射应成为所有对初始化疗有反应的小细胞肺癌（SCLC）患者标准治疗的一部分。他们报告的一项临床试验显示这项措施显著降低了脑转移率，延长了无病生存期和总生存期。
The study, headed by Ben Slotman, MD, PhD, from VU University Medical Center, in Amsterdam, the Netherlands, is published in the August 16 issue of the New England Journal of Medicine. Results were presented earlier this year at the American Society of Clinical Oncology annual meeting and were commented on favorably by other lung cancer experts, as reported by Medscape at the time.
由荷兰阿姆斯特丹VU大学医学中心Ben Slotman博士领导的这项研究发表在8月16日的《新英格兰医学杂志》上。该研究结果已在今年早些时候举行的美国临床肿瘤学年会上报告，其他肺癌专家对此结果也持赞同态度，当时Medscape网站报道了此事。
Brain metastases are common in patients with SCLC, the researchers comment. At least 18% of patients already have brain metastases at diagnosis, and the incidence increases during the course of the disease, up to 80% at 2 years. Previous clinical trials have shown unequivocally that prophylactic cranial irradiation reduces the risk for brain metastases in patients with limited SCLC, but there has been uncertainty over its role in patients with extensive disease, Dr. Slotman and colleagues explain. Hence they studied this specific patient population and report: \"Our study shows a clear advantage.\"
研究者解释道，SCLC病人脑转移很常见。至少18%的病人在确诊时已有脑转移，而脑转移发生率随疾病进展而增加，2年发生率达80%。
过去的临床试验已明确显示预防性头颅照射降低了局限性的小细胞肺癌患者脑转移的风险，但其对广泛转移的病人效果如何尚不清楚，Slotman及其同事解释道。因此他们研究了这个特殊的病人群体后称：“我们的研究表明疗效明显”
The study, carried out in 286 patients with extensive SCLC who had responded to systemic chemotherapy, compared prophylactic cranial irradiation with no further therapy. After a 1-year follow-up, patients in the radiation group had a significantly lower risk for symptomatic brain metastases (14.6% vs 40.4% in the control group; hazard ratio [HR], 0.27). There was also a significant effect on overall survival at 1 year (27.1% vs 13.3% in the control group; HR, 0.68), with a prolongation of median survival by 6 weeks.
这项研究纳入286例对全身化疗有反应的广泛转移小细胞肺癌患者，来比较预防性全脑放疗和无其他进一步治疗的结果。经过一年的随访，放疗组较对照组发生有症状脑转移的风险明显降低（放疗组为14.6%，对照组为40.4%；风险比0.27）。一年时总体生存率也有明显区别（病例组27.1%，而对照组为13.3%，风险比0.68），病例组中位生存期延长了6周。
\"A noteworthy finding in our study,\" the authors note, \"was that patients with extracranial progression who had also undergone cranial irradiation were more often treated for the progression than those in the control group (68.0% vs 45.1%).\" This was more than would be expected, as previous studies have reported that only 42% of patients were suitable for second-line chemotherapy at the time of disease progression, and the remaining patients were suitable only for supportive care, they comment.
作者特别提到：“一个值得注意的发现是进行全脑放疗的颅外进展患者因进展而治疗的比例（68.0%）较对照组（45.1%）高。”他们认为，这比先前预料的要高，以前的研究报道仅有42%的病人在疾病进展时适于二线化疗，剩下的病人仅适合支持治疗。
One unresolved question that remains relates to the best dose of radiation to use. At the American Society of Clinical Oncology meeting, discussant for the paper, Andrew Turrisis, MD, from the Karmanos Cancer Center, in Detroit, Michigan, noted that the researchers had used less radiation than is commonly administered in the United States, where 24 to 30 Gy in 8 to 12 fractions is common. In contrast, the majority of patients (88/143) in the current study received only 20 Gy in 5 fractions, and yet \"an impressive reduction in the risk for brain metastases was still seen,\" Dr. Slotman and colleagues write. They also suggest that, rather than waste resources on further addressing this question of dose, priority should be given to the \"more pressing concern\" of the extracranial progression rate of about 90% seen in these patients.
剩下一个尚未解决的问题是关于最佳放射剂量的。在美国临床肿瘤学年会上，密歇根州底特律市Karmanos癌症中心的Andrew Turrisis博士讨论报告时注意到研究者应用的放射剂量比美国通常应用的要小，在美国常将24~30Gy分割成8~12次照射。相反，本研究中大多数病人（88/143）仅接受了20Gy分5次照射，而且Slotman等还写道“仍然可见到脑转移危险明显降低。”他们还建议与其浪费资源探讨放射剂量，还不如优先考虑更为紧迫的问题——这些病人中有约90%的颅外进展率。
N Engl J Med. 2007;357:664-672.
http://www.medscape.com/viewarticle/561460
编译后
预防性头颅照射应成为化疗反应性小细胞肺癌的标准治疗的一部分
Zosia Chustecka
2007年8月15日——研究者称预防性头颅照射应成为所有对初始化疗有反应的小细胞肺癌（SCLC）患者标准治疗的一部分。他们报告的一项临床试验显示这项措施显著降低了脑转移率，延长了无病生存期和总生存期。
由荷兰阿姆斯特丹VU大学医学中心Ben Slotman博士领导的这项研究发表在8月16日的《新英格兰医学杂志》上。该研究结果已在今年早些时候举行的美国临床肿瘤学年会上报告，其他肺癌专家对此结果也持赞同态度，当时Medscape网站报道了此事。
研究者解释道，SCLC病人脑转移很常见。至少18%的病人在确诊时已有脑转移，而脑转移发生率随疾病进展而增加，2年发生率达80%。
过去的临床试验已明确显示预防性头颅照射降低了局限性的小细胞肺癌患者脑转移的风险，但其对广泛转移的病人效果如何尚不清楚，Slotman及其同事解释道。因此他们研究了这个特殊的病人群体后称：“我们的研究表明疗效明显”
这项研究纳入286例对全身化疗有反应的广泛转移小细胞肺癌患者，来比较预防性全脑放疗和无其他进一步治疗的结果。经过一年的随访，放疗组较对照组发生有症状脑转移的风险明显降低（放疗组为14.6%，对照组为40.4%；风险比0.27）。一年时总体生存率也有明显区别（病例组27.1%，而对照组为13.3%，风险比0.68），病例组中位生存期延长了6周。
作者特别提到：“一个值得注意的发现是进行全脑放疗的颅外进展患者因进展而治疗的比例（68.0%）较对照组（45.1%）高。”他们认为，这比先前预料的要高，以前的研究报道仅有42%的病人在疾病进展时适于二线化疗，剩下的病人仅适合支持治疗。
剩下一个尚未解决的问题是关于最佳放射剂量的。在美国临床肿瘤学年会上，密歇根州底特律市Karmanos癌症中心的Andrew Turrisis博士讨论报告时注意到研究者应用的放射剂量比美国通常应用的要小，在美国常将24~30Gy分割成8~12次照射。相反，本研究中大多数病人（88/143）仅接受了20Gy分5次照射，而且Slotman等还写道“仍然可见到脑转移危险明显降低。”他们还建议与其浪费资源探讨放射剂量，还不如优先考虑更为紧迫的问题——这些病人中有约90%的颅外进展率。 |
发表于 2007-8-30 21:29:18