The Optimal Radiotherapy Strategy for Patients With Small Cell Lung Cancer and Brain Metastasis: A Retrospective Analysis

IF 4.8 1区医学 Q1 NEUROSCIENCES CNS Neuroscience & Therapeutics Pub Date : 2024-11-05 DOI:10.1111/cns.70102

Qian Zeng, Xianjing Chu, Gang Xiao, Jing Zhang, Yingying Zhang, Bin Long, Lei Yang, Zhaohua Tan, Rongrong Zhou

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Abstract

Background

Extensive-stage small cell lung cancer (ES-SCLC) is a notoriously aggressive malignancy frequently associated with brain metastases (BMs), presenting substantial therapeutic challenges. This study delves into the effectiveness of immunotherapy combined with diverse radiotherapy, especially the influence of brain radiotherapy (BRT) on survival outcomes in the immunotherapy era.

Methods

ES-SCLC patients treated at Xiangya Hospital and Xiangya Boai Hospital from February 2020 to June 2024 were retrospectively included. The study focused on patients receiving immune checkpoint inhibitors (ICIs). Metrics included overall survival (OS) and progression-free survival (PFS), employing univariate and multivariate Cox regression models for statistical analysis.

Results

A total of 393 patients with ES-SCLC who received ICIs were included in the study. Within the entire cohort, the presence of baseline BMs did not statistically affect OS or PFS. However, thoracic radiotherapy (TRT) was identified as a favorable prognostic factor for both OS and PFS. BRT demonstrated a beneficial effect on OS across both the general cohort and the baseline_BMs subgroup. In patients from the baseline_BMs subgroup who had previously undergone TRT, ICIs plus BRT did not significantly improve OS compared to ICIs alone. Conversely, for patients who had not received prior TRT, adding BRT to ICIs significantly enhanced OS. Among the patients who underwent BRT, 71 received whole brain radiotherapy (WBRT) while 19 opted for stereotactic radiosurgery (SRS). No significant differences in OS and PFS were observed between the SRS and WBRT modalities. The sequence of ICIs relative to BRT was found to influence PFS adversely. Administering BRT before ICIs (RT-ICI) was associated with worse PFS compared to administering ICIs followed by BRT (ICI-RT). Additionally, no significant differences in OS and PFS were noted among the three subgroups defined by varying intervals between ICIs and BRT. For patients without baseline BMs, TRT and prophylactic cranial irradiation were associated with delayed onset of brain metastases.

Conclusions

Our study underscores the importance of optimizing treatment strategies and considering the timing and integration of radiotherapy and immunotherapy to improve outcomes for patients with ES-SCLC, particularly those at risk of or presenting with BMs.

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小细胞肺癌脑转移患者的最佳放疗策略：回顾性分析

背景：广泛期小细胞肺癌（ES-SCLC）是一种臭名昭著的侵袭性恶性肿瘤，经常伴有脑转移（BMs），给治疗带来了巨大挑战。本研究探讨了免疫治疗与多样化放疗相结合的有效性，尤其是在免疫治疗时代脑放疗（BRT）对生存结果的影响：回顾性纳入2020年2月至2024年6月在湘雅医院和湘雅博爱医院接受治疗的ES-SCLC患者。研究重点是接受免疫检查点抑制剂（ICIs）治疗的患者。指标包括总生存期（OS）和无进展生存期（PFS），采用单变量和多变量Cox回归模型进行统计分析：研究共纳入了393名接受ICIs治疗的ES-SCLC患者。在整个队列中，基线BMs的存在对OS或PFS没有统计学影响。然而，胸腔放疗（TRT）被认为是OS和PFS的有利预后因素。胸腔放疗对总体队列和基线_BMs亚组的OS均有益处。在曾接受过 TRT 的基线_BMs 亚组患者中，与单用 ICIs 相比，ICIs 加 BRT 并未显著改善 OS。相反，对于之前未接受过 TRT 的患者，在 ICIs 的基础上加用 BRT 能显著提高 OS。在接受 BRT 的患者中，71 人接受了全脑放射治疗（WBRT），19 人选择了立体定向放射手术（SRS）。在 OS 和 PFS 方面，SRS 和 WBRT 两种模式之间没有发现明显差异。研究发现，ICIs相对于BRT的顺序会对PFS产生不利影响。与先进行 ICIs 后进行 BRT（ICI-RT）相比，先进行 BRT 再进行 ICIs（RT-ICI）的 PFS 更差。此外，根据 ICIs 和 BRT 之间的不同时间间隔定义的三个亚组在 OS 和 PFS 方面没有明显差异。对于没有基线脑转移灶的患者，TRT和预防性头颅照射与脑转移灶的延迟发生有关：我们的研究强调了优化治疗策略、考虑放疗和免疫治疗的时机和整合的重要性，以改善ES-SCLC患者的预后，尤其是有脑转移风险或出现脑转移的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.