JTO: SCLC预防性脑照射伴或不伴海马保护的3期随机试验

2021-04-29 MedSci原创 MedSci原创

根据疾病分期及特征,小细胞肺癌患者的脑转移(brain metastases,BM)发生率非常高,超过50%。BM患者预后不佳,生活质量下降。

根据疾病分期及特征,小细胞肺癌患者的脑转移(brain metastases,BM)发生率非常高,超过50%。BM患者预后不佳,生活质量下降。预防性脑照射(phylactic cranial irradiation,PCI)可显著降低BM,并在一定程度上提高总生存率(OS)。但PCI会产生副作用,其中包括长期的神经认知功能下降。

目前,有研究已经提出了几种解释神经认知衰退的相互作用机制,其中包括血管病变、少突胶质细胞减少、中枢神经系统炎症和海马体中祖细胞生态退化,而海马体是学习和记忆的重要结构。海马功能受PCI影响最大。

现代放射治疗技术,如调强适形放射治疗和容积弧形调强放射治疗,允许以标准放射剂量治疗整个大脑但同时保持对海马的低剂量照射。本研究是一项多中心随机3期试验,旨在探讨比较小细胞肺癌患者接受PCI加或不加海马保护(hippocampus avoidance,HA)后的神经认知功能。

本研究将小细胞肺癌患者随机分为2组,接受剂量为2.5Gy*10f的标准PCI或HA-PCI治疗。主要终点是在4个月时测试霍普金斯词汇学习测验-修订版,如果与基线相比至少下降5个点则被视为失败。次要终点包括其他认知结果、发病率评估、脑转移位置和总生存率。

表1  所有接受HA-PCI治疗患者的治疗计划

在2013年4月至2018年3月,本研究共随机入组168名患者。中位随访时间为26.6个月。在两个治疗组中,70%的患者疾病有限,基线特征良好。在4个月时测定的霍普金斯词汇学习测验-修订版总回忆评分的下降在两组之间没有显著差异:29%接受PCI治疗的患者和28%接受HA-PCI治疗的患者下降大于或等于5分(p =1.000)。

在其他认知测试如测试记忆、执行功能、注意力、运动功能和处理速度的表现在两组之间没有显著差异。总生存率无显著性差异(p = 0.43)。PCI组2年的脑转移累积发生率为20%(95%CI:12%-29%),HA-PCI组为16%(95%CI:7%-24%)。

综上所述,本研究结果表明,与传统的PCI相比,小细胞肺癌患者接受HA-PCI的神经认知功能下降的概率并未发现有所减低。

Belderbos, José S.A. et al. Phase 3 Randomized Trial of Prophylactic Cranial Irradiation With or Without Hippocampus Avoidance in SCLC (NCT01780675). Journal of Thoracic Oncology, Volume 16, Issue 5, 840 - 849

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    2021-04-30 MedSciZeng

    #JTO#点击进入话题查看更多相关文章 或评论时插入话题加入讨论

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  4. [GetPortalCommentsPageByObjectIdResponse(id=2034853, encodeId=53e9203485304, content=<a href='/topic/show?id=69c910030635' target=_blank style='color:#2F92EE;'>#预防性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100306, encryptionId=69c910030635, topicName=预防性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45b2276, createdName=839640778, createdTime=Fri Oct 01 01:00:18 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1512178, encodeId=e13415121e883, content=<a href='/topic/show?id=cfd19846697' target=_blank style='color:#2F92EE;'>#随机试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98466, encryptionId=cfd19846697, topicName=随机试验)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c3710444656, createdName=124985dbm09(暂无昵称), createdTime=Sat May 01 13:00:18 CST 2021, time=2021-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=961949, encodeId=cea5961949dc, content=<a href='/topic/show?id=e73d1042656b' target=_blank style='color:#2F92EE;'>#JTO#</a>点击进入话题查看更多相关文章 或评论时插入话题加入讨论, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104265, encryptionId=e73d1042656b, topicName=JTO)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Fri Apr 30 17:45:12 CST 2021, time=2021-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1039020, encodeId=2dd51039020a6, content=高质量研究,读起来真爽,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Fri Apr 30 01:00:18 CST 2021, time=2021-04-30, status=1, ipAttribution=)]
    2021-04-30 肿瘤克星

    高质量研究,读起来真爽,谢谢梅斯

    0

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