广泛期小细胞肺癌胸部放疗的价值

发表在European Journal of Cancer上的一篇系统综述及荟萃分析显示：广泛期小细胞肺癌患者化疗后巩固胸部放疗，能提高无进展生存期，能减少胸内复发率。但是未能明显提高总生存期。作者建议应个体化地应用胸部放疗，如化疗有效的患者，胸部病变残存的患者及胸外转移灶数目较少的患者，因胸内复发风险较高，应用胸部放疗能够提高获益。下一步需要进一步开展研究，以确定广泛期小细胞肺癌的高危亚组人群进行胸部放疗，以提高总生存。针对广泛期肺癌的分类（寡转移及多灶性转移）进行优化放疗的策略（序贯及同步）及放疗剂量是很有必要的。

In summary, we present a systematic review and meta-analysis of RCT evaluating cRT in ES-SCLC. Thoracic cRT offers significant PFS improvement, a significant reduction in thoracic progression as the first site of progression, however, did not show significant OS benefit. We support use of cRT in ES-SCLC to be considered on a case-by-case basis. Patients with response to CT, residual intrathoracic disease and limited extrathoracic disease to might be at a higher risk of intrathoracic progression. Use of cRT in this popu- lation may yield maximum benefit and would be appropriate. Further research to identify the subset of ES-SCLC likely to have significant OS benefit is needed.

Strategies focussing on subclassification of ES-SCLC (limited vs extensive metastasis) optimise strategy for RT integration (sequential vs concurrent), and optimal RT dose might be helpful.

Our meta-analysis of 3 randomised controlled studies shows consolidation thoracic RT offers significant improvement in PFS and reduction in thoracic failures. Use of cRT in ES-SCLC should be considered on a case- by-case basis. Further research to identify the subset of ES-SCLC likely to have significant OS benefit is needed.

参考文献：https://doi.org/10.1016/j.ejca.2019.01.003

European Journal of Cancer 110 (2019) 110e119

Role of thoracic consolidation radiation in extensive stage small cell lung cancer: A systematic review and meta-analysis of randomised controlled trials

Shrinivas Rathoda,*, Branislav Jeremicb, Arbind Dubeya,
Meredith Giulianic, Bashir Bashira, Amitava Chowdhurya, You Liangd, Sandra Pereirad, JaiPrakash Agarwale, Rashmi Koula