期刊
JOURNAL OF RADIATION RESEARCH
卷 63, 期 4, 页码 636-645出版社
OXFORD UNIV PRESS
DOI: 10.1093/jrr/rrac035
关键词
limited-stage small-cell lung cancer (LS-SCLC); prophylactic cranial irradiation (PCI); brain metastasis (BM); pro-gastrin-releasing peptide (ProGRP); tumor marker
资金
- Japan Agency for Medical Research and Development (AMED) [JP20ck0106581]
This study found that elevated pretreatment pro-gastrin-releasing peptide (ProGRP) levels were associated with an increased risk of brain metastasis in LS-SCLC patients. Prophylactic cranial irradiation (PCI) may help reduce the risk of brain metastasis, particularly in patients with higher ProGRP levels. These results provide a reliable method for determining which LS-SCLC patients should undergo PCI.
Prophylactic cranial irradiation (PCI) is recommended for patients with limited-stage small-cell lung cancer (LS-SCLC) who respond well to initial treatment. However, PCI is often omitted because of its potential neurotoxicity in the era of modern diagnostic imaging devices. In the present study, we aimed to investigate the risk factors for brain metastasis (BM) in patients eligible for PCI and who may benefit more from it. Patients with LS-SCLC who responded well to definitive thoracic chemoradiotherapy were included in the present study. Competing risk regression was used to identify factors associated with BM, and the Kaplan-Meier method was used to assess overall survival (OS). Between 2004 and 2017, 62 patients were eligible for PCI and were analyzed. Of these, 38 (61.3%) underwent PCI. Overall, 17 patients (27.4%) developed BM, with a 2-year cumulative incidence of 22.8%. Multivariate analysis (MVA) revealed that pretreatment elevated pro-gastrin-releasing peptide (ProGRP) levels were associated with an increased risk for BM (HR, 7.96, P = 0.0091). PCI tended to reduce the risk of BM (HR, 0.33; P = 0.051). The use of PCI was associated with improved OS in patients with ProGRP levels > 410 pg/mL (P = 0.008), but not in those with ProGRP <= 410 pg/mL (P = 0.9). Pretreatment ProGRP levels may be useful in predicting the development of BM in patients with LS-SCLC who achieved a good response to initial therapy and to determine which patients should undergo PCI.
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