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Long-Term Survival with No Evidence of Brain Metastasis in 6 Patients of Limited-Stage Small Cell Lung Cancer Receiving Prophylactic Cranial Irradiation

侷限型小細胞肺癌病人接受預防性腦部照射後長期存活且無腦部轉移

摘要


目的:小細胞肺癌病人在初始治療之後若達到局部完全緩解,通常會建議接受預防性腦部放射線照射。在本文中,我們報告了6位侷限型小細胞肺癌病人接受預防性腦部照射後,持續3年以上無腦部轉移。 材料與方法:自1998年11月至2002年l月,有6位診斷為小細胞肺癌的病人。其中5位(83%)是男性,l位(17%)是女性。病人的平均年齡是61歲。所有病人的癌症期別皆為侷限期小細胞肺癌。根據ECOG (Eastern Cooperative Oncology Group) performance status狀態來評分,l位病人(17%)是ECOG 0,4位(66%)是ECOG 1,l位(17%)是ECOG 2。所有病人皆接受同步化學與放射線治療。化學治療的藥物為Cisplatin與Etoposide。肺部的放射線治療劑量中位數為54 Gy。所有6位病人皆達到局部完全緩解,並且接受總劑量中位數為36 Gy的預防性腦部放射線照射。 結果:所有6位病人在最近一次追蹤中皆存活,並且持續3年以上無腦部轉移。最長的追蹤時間為75個月。3位病人(50%)有腦部以外的轉移,包括了2位病人有骨轉移,l位病人有腎臟轉移。 結論:侷限型小細胞肺癌病人在同步化學治療與放射線治療後,若達到完全緩解並且接受預防性腦部照射,可以達到長期存活且無腦部轉移的結果。不過,一半以上的病人仍舊有腦部以外的遠端轉移。相對於其他部位的轉移,預防性腦部放射線照射能夠有效避免腦部轉移的發生。

並列摘要


Background: Prophylactic cranial irradiation (PCI) is generally suggested for limited-staged small cell lung cancer (SCLC) patients with complete local response to initial therapies. We presented 6 patients with no evidence of brain metastasis for more than 3-year follow-up after receiving PCI. Materials and Methods: From November 1998 through January 2002, 6 patients were diagnosed as SCLC in our institution. Five patients (83%) were male and 1 (17%) was female. The median age at diagnosis was 61 years. All patients were classified as limited stage. According to ECOG (Eastern Cooperative Oncology Group) performance status, 1 patient (17%) was scaled to 0, 4 patients (66%) were 1, and 1 patient (17%) was 2. All patients were treated with concurrent chemoradiotherapy (CCRT). Chemotherapy regimens consisted of cisplatin and etoposide. The median cumulative thoracic irradiation dose was 54Gy. All 6 patients achieved complete local response after CCRT, and then they received PCI with median cumulative dose of 36Gy. Results: All patients were alive and had a long-term follow-up more than 3 years with no evidence of brain metastasis. The longest follow-up duration was 75 months. Three patients (50%) had metastasis to distant sites other than brain, including 2 patients with bone and one patient with kidney metastases. Conclusions: In our study, long-term survival with no evidence of brain metastasis was achieved in patients of SCLC receiving PCI after complete local response to initial treatments of CCRT. Distant metastases to other sites still developed in half of these patients. PCI might have benefits in preventing distant metastasis to brain on the respect of failures to other distant sites with long-term follow-up.

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