ASCO 2014：预防性颅脑照射具高危脑转移风险的IIIA N2期NSCLC可延长患者生存

2014-05-31 刘揆亮译医学论坛网

摘要号：#7508 第一作者：王思愚，中山大学附属肿瘤医院胸外科充分切除并辅助化疗后具有高危脑转移风险的IIIA N2期非小细胞肺癌患者中预防性颅脑照射与观察进行比较的随机试验背景：预防性颅脑照射（PCI）明显降低非小细胞肺癌（NSCLC）患者脑转移的发生率，不过对于生存的影响不明确。之前我们建立了一项预测局部进展期NSCLC患者发生脑转移危险的数学模型。本研究的目的是在已切除病变并接受

摘要号：#7508

第一作者：王思愚，中山大学附属肿瘤医院胸外科

充分切除并辅助化疗后具有高危脑转移风险的IIIA N2期非小细胞肺癌患者中预防性颅脑照射与观察进行比较的随机试验

背景：预防性颅脑照射（PCI）明显降低非小细胞肺癌（NSCLC）患者脑转移的发生率，不过对于生存的影响不明确。之前我们建立了一项预测局部进展期NSCLC患者发生脑转移危险的数学模型。本研究的目的是在已切除病变并接受辅助化疗，具有脑转移高危因素的IIIA N2期NSCLC患者中评价PCI是否可改善生存。

方法：这项开放性随机研究中，对于患IIIA N2期NSCLC，病变已完全切除，没有复发，接受了术后辅助化疗，具有脑转移高危因素的患者随机安排接受PCI （30 Gy ，分10次照射）或观察处理。主要终点为无病生存期（DFS）。次要终点包括脑转移发生率、总体生存（OS）和不良反应。

结果：2005年1月至 2009年1月， 156名符合标准的患者接受随机分配（PCI组81名，对照组75名）。本研究由于受试者入组缓慢而提前中止。PCI组相比于对照组明显延长了DFS，中位DFS分别为28.5 个月和 21.2个月（危险比[HR] 0.67，95%可信区间 [CI] 0.46-0.98，P=0.037）。 PCI组3年和5年DFS 分别为42.0% 和26.1%，观察组为29.8% 和18.5%。PCI与脑转移危险下降相关（5年脑部复发率13.6% 与41.3%，优势比0.223，95% CI 0.102-0.489，P<0.001）。PCI组中位OS 31.2 个月，对照组为27.4个月（HR, 0.81; 95% CI, 0.56-1.16; P=0.310）。 PCI组3年和5年 OS分别为44.5%和 27.4%，观察组为38.7%和22.8% 。而PCI组主要不良反应为头痛、恶心/呕吐和乏力，症状大多轻微。

结论：病变充分切除及辅助化疗后具有高危脑转移风险的IIIA N2 NSCLC患者中，PCI延长了 DFS，降低了脑转移发生率。

研究链接：A randomized trial of prophylactic cranial irradiation versus observation in patients with fully resected stage IIIA N2 non-small cell lung cancer and high risk of cerebral metastases after adjuvant chemotherapy. (Abstract 7508)

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2015-04-02 12498da4m32(暂无昵称)

#转移风险#

88 0
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2014-06-24 quxin068

#ASC#

94 0
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2014-10-31 tastas

#患者生存#

55 0
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2015-01-22 juliusluan78

#III#

0 0
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2014-08-08 839640778

#预防性#

77 0

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