Rades Dirk, Pluemer Andre, Veninga Theo, Schild Steven E
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Strahlenther Onkol. 2008 Nov;184(11):565-71. doi: 10.1007/s00066-008-1908-1. Epub 2008 Nov 19.
Elderly patients are often treated differently than younger individuals due to concerns regarding tolerance and survival. This analysis was performed to evaluate whether elderly patients with one to two brain metastases would benefit from relatively aggressive approaches. It compares whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), resection plus WBRT (OP + WBRT), and resection plus WBRT plus boost (OP + WBRT + boost) in elderly patients.
One-hundred-and-sixty-four patients aged > or = 65 years with one to two brain metastases treated with WBRT (n = 34), SRS (n = 43), OP + WBRT (n = 41), or OP + WBRT + boost (n = 46) were included. The groups were compared retrospectively regarding survival (OS), intracerebral control (IC), and local control of treated metastases (LC). Six additional potential prognostic factors were evaluated: gender, performance status, tumor type, number of brain metastases, extracerebral metastases, and interval from tumor diagnosis to irradiation.
1-year OS was 17% after WBRT, 40% after SRS, 27% after OP + WBRT, and 61% after OP + WBRT + boost. On multivariate analysis, treatment regimen (RR: 1.67; p = 0.043), no extracerebral metastases (RR: 2.85; p < 0.001), and longer interval from tumor diagnosis to irradiation (RR: 1.78; p = 0.002) were associated with improved OS. 1-year IC was 17%, 55%, 36%, and 79%, respectively. On multivariate analysis, treatment (RR: 2.83; p < 0.001), single brain metastasis (RR: 1.80; p = 0.021), and longer interval (RR: 2.02; p = 0.004) were associated with improved IC. 1-year LC was 19%, 68%, 43%, and 84%, respectively. On multivariate analysis, treatment (RR: 3.31; p < 0.001), single brain metastasis (RR: 1.76; p = 0.047), and longer interval (RR: 1.89; p = 0.015) were associated with improved LC.
OP + WBRT + boost appeared to provide the best outcomes of the compared treatment regimens in elderly patients with one to two brain metastases. If surgery is not possible, SRS may be considered.
由于对耐受性和生存期的担忧，老年患者的治疗方式通常与年轻患者不同。本分析旨在评估一至两个脑转移瘤的老年患者是否能从相对积极的治疗方法中获益。对老年患者的全脑放疗（WBRT）、立体定向放射外科治疗（SRS）、手术切除加WBRT（OP + WBRT）以及手术切除加WBRT加推量放疗（OP + WBRT + 推量放疗）进行比较。
纳入164例年龄≥65岁、有一至两个脑转移瘤的患者，分别接受WBRT（n = 34）、SRS（n = 43）、OP + WBRT（n = 41）或OP + WBRT + 推量放疗（n = 46）。对各组患者的总生存期（OS）、脑内控制（IC）以及治疗转移瘤的局部控制（LC）进行回顾性比较。评估另外六个潜在的预后因素：性别、体能状态、肿瘤类型、脑转移瘤数量、脑外转移瘤以及从肿瘤诊断到放疗的时间间隔。
WBRT后1年总生存率为17%，SRS后为40%，OP + WBRT后为27%，OP + WBRT + 推量放疗后为61%。多因素分析显示，治疗方案（风险比：1.67；p = 0.043）、无脑外转移瘤（风险比：2.85；p < 0.001）以及从肿瘤诊断到放疗的时间间隔较长（风险比：1.78；p = 0.002）与总生存期改善相关。1年脑内控制率分别为17%、55%、36%和79%。多因素分析显示，治疗（风险比：2.83；p < 0.001）、单个脑转移瘤（风险比：1.80；p = 0.021）以及时间间隔较长（风险比：2.02；p = 0.004）与脑内控制改善相关。1年局部控制率分别为19%、68%、43%和84%。多因素分析显示，治疗（风险比：3.31；p < 0.001）、单个脑转移瘤（风险比：1.76；p = 0.047）以及时间间隔较长（风险比：1.89；p = 0.015）与局部控制改善相关。
对于有一至两个脑转移瘤的老年患者，OP + WBRT + 推量放疗似乎在比较的治疗方案中能提供最佳疗效。若无法进行手术，可考虑SRS。
