全脑放射治疗对脑转移瘤伽玛刀放射外科治疗后存活超过一年患者的长期控制及发病率的影响。

PURPOSE: To better analyze how whole-brain radiotherapy (WBXRT) affects long-term tumor control and toxicity from the initial stereotactic radiosurgery (SRS) for brain metastases, we studied these outcomes in patients who had survived at least 1 year from SRS. METHODS AND MATERIALS: We evaluated the results of gamma knife radiosurgery for 160 brain metastases in 110 patients who were followed for a median of 18 months (range, 12-122 months) after SRS. Eighty-two patients had a solitary brain metastasis and 28 patients had multiple metastases. Seventy patients (116 tumors) were treated with initial radiosurgery and WBXRT, whereas 40 patients (44 lesions) initially received radiosurgery alone. Median treatment volume was 1.9 cc in the entire group, 2.3 cc in the WBXRT group, and 1.6 cc in the SRS alone group. Median tumor dose was 16 Gy (range, 12-21 Gy). RESULTS: At 1, 3, and 5 years, local tumor control was 84.1% +/- 5.5%, 68.6% +/- 8.7%, and 68.6% +/- 8.7% with SRS alone compared with 93.1% +/- 2.4%, 87.7% +/- 4.9%, and 65.7% +/- 10.2%. with concurrent WBXRT and SRS (p = 0.0228, univariate). We found that WBXRT improved local control in patient subsets tumor volume > or =2 cc, peripheral dose < or =16 Gy, single metastases, nonradioresistant tumors, and lung cancer metastases (p = 0.0069, 0.0080, 0.0083, 0.0184, and 0.0348). Distal intracranial failure developed at 1, 3, and 5 years in 26.0% +/- 7.1%, 74.5% +/- 9.4%, and 74.5% +/- 9.4% with SRS alone compared with 20.7% +/- 4.9%, 49.0% +/- 8.7%, and 61.8% +/- 12.8% with concurrent WBXRT and SRS (p = 0.0657). We found a trend for improved distal intracranial control with WBXRT for only nonradioresistant tumors (p = 0.054). Postradiosurgery complications developed in 2.8% +/- 1.2% and 10.7% +/- 3.5% at 1 and 3-5 years and was unaffected by WBXRT (p = 0.7721). WBXRT did not improve survival in the entire series (p = 0.5027) or in any subsets. CONCLUSIONS: In this retrospective study of 1-year survivors of SRS for brain metastases, the addition of concurrent WBXRT to SRS was associated with an improved local control rate in patient subsets with tumor volume > or =2 cc, peripheral dose < or =16 Gy, single metastases, nonradioresistant tumors, and specifically lung cancer metastases. A trend was noted for improved distal intracranial control for patients having nonradioresistant tumors. Distant intracranial relapse >1 year posttreatment is a significant problem with or without initial WBXRT.

目的：为了更好地分析全脑放疗（WBXRT）如何影响脑转移瘤初始立体定向放射外科治疗（SRS）后的长期肿瘤控制和毒性，我们对SRS后存活至少1年的患者的这些结果进行了研究。方法和材料：我们评估了110例患者中160个脑转移瘤的伽玛刀放射外科治疗结果，这些患者在SRS后中位随访18个月（范围12 - 122个月）。82例患者有单个脑转移瘤，28例患者有多个转移瘤。70例患者（116个肿瘤）接受了初始放射外科治疗和WBXRT，而40例患者（44个病灶）最初仅接受了放射外科治疗。整个组的中位治疗体积为1.9 cc，WBXRT组为2.3 cc，单纯SRS组为1.6 cc。中位肿瘤剂量为16 Gy（范围12 - 21 Gy）。结果：在1年、3年和5年时，单纯SRS的局部肿瘤控制率分别为84.1%±5.5%、68.6%±8.7%和68.6%±8.7%，而同步WBXRT和SRS的局部肿瘤控制率分别为93.1%±2.4%、87.7%±4.9%和65.7%±10.2%（单因素分析，p = 0.0228）。我们发现WBXRT在肿瘤体积≥2 cc、周边剂量≤16 Gy、单个转移瘤、非放射抗拒性肿瘤和肺癌转移瘤的患者亚组中改善了局部控制（p = 0.0069、0.0080、0.0083、0.0184和0.0348）。单纯SRS在1年、3年和5年时远处颅内失败发生率分别为26.0%±7.1%、74.5%±9.4%和74.5%±9.4%，而同步WBXRT和SRS的远处颅内失败发生率分别为20.7%±4.9%、49.0%±8.7%和61.8%±12.8%（p = 0.0657）。我们发现仅对于非放射抗拒性肿瘤，WBXRT有改善远处颅内控制的趋势（p = 0.054）。放射外科治疗后并发症在1年和3 - 5年时分别为2.8%±1.2%和10.7%±3.5%，不受WBXRT影响（p = 0.7721）。WBXRT在整个系列中或任何亚组中均未改善生存率（p = 0.5027）。结论：在这项对脑转移瘤SRS后1年存活患者的回顾性研究中，同步WBXRT联合SRS与肿瘤体积≥2 cc、周边剂量≤16 Gy、单个转移瘤、非放射抗拒性肿瘤特别是肺癌转移瘤的患者亚组局部控制率提高相关。对于非放射抗拒性肿瘤患者，有远处颅内控制改善的趋势。治疗后1年以上远处颅内复发是一个显著问题，无论是否初始采用WBXRT。

新学期，新优惠

Suppr 超能文献

新学期，新优惠

Suppr 超能文献

The impact of whole-brain radiation therapy on the long-term control and morbidity of patients surviving more than one year after gamma knife radiosurgery for brain metastases.

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