抽象
在任何具有早期非小细胞肺癌的患者中没有考虑具有治疗意图的治疗的患者的反射脑MRI没有地方http://ow.ly/I5O530kI5vQ
To the Editor:
关于肺癌分期的更新欧洲呼吸杂志[1] is a welcome overview of a field characterised by fast evolution of therapeutic modalities. The accurate staging of lung cancer is of utmost importance for an optimal outcome. Since value of care incorporates outcome over cost as a surrogate of the quality achieved [2],必须非常关注推荐必要的分期调查。
我们进一步关注非小细胞肺癌患者中枢神经系统成像的建议。R.ami-POrta.et al.[1] recommend cerebral imaging in all patients with curative therapeutic options, preferably by magnetic resonance imaging (MRI).
虽然没有人怀疑脑转移检测的预后重要性,但我们还应该考虑调查对超出个体患者水平的最终结果的影响。许多年龄较大,最近的研究调查了隐匿性脑转移的患病率[3–5]。肿瘤大小,节点转移和肿瘤类型的存在均出现预测性[6]。The overall prevalence in patients in whom a resection is planned ranges from 1% to 3% [3,4,6]。MRI is marginally better than contrast-enhanced computed tomography of the brain [3]。在氟脱氧葡萄糖正电子发射断层扫描之前的大多数源自常规实践中的数据,这意味着上述数字符合选择偏差。在患有局部晚期肺癌的患者中,患病率> 15%[5]。除了流行,还应该考虑成本。最近可重症肺癌患者的评估估计,32%的分期成本来自脑MRI,尽管转移的患病率仅为1.3%[4]。Additional imaging can also cause treatment delays and increase the psychological burden on the patient. There are several reports on incidental or of false-positive findings leading to the denial of curative therapy.
In stage III, the indication for brain imaging is definite in all guidelines, taking into account the burden of multimodality treatments. There is, however, remarkable inconsistency in recommendations for patients with stages I–II. The American College of Chest Physicians recommends the brain should not be scanned in these patients [7]。2018年发布的全国综合癌症网络指南有一个阶段IB-II的建议,但不是阶段IA [8]。国家卫生保健研究所(尼斯)指南(2011年)和欧洲医学肿瘤学会指南(2017年)说明大脑的MRI对治疗意图的患者有用,很好地添加了这项评论,特别是这项评论III阶段肺癌患者的病例[9,10]。
在我们看来,与所有患者表现脑MRI的建议对比[1],更具限制性的策略是可防力的,特别是对于那些患脑转移的风险低的人。对前瞻性研究有明确的未满足需求,以优化这些患者患有严重肺病的患者的护理价值。
脚注
Conflict of interest: None declared.
- 收到2018年6月11日。
- AcceptedJune 23, 2018.
- 版权所有©ers 2018