Department of Radiation Oncology, University Hospital Schleswig-Holstein, Lubeck, Germany.
Int J Radiat Oncol Biol Phys. 2010 Jun 1;77(2):537-41. doi: 10.1016/j.ijrobp.2009.05.001. Epub 2009 Sep 3.
The majority of patients with brain metastases from melanoma receive whole-brain radiotherapy (WBRT). However, the results are poor. Hypofractionation regimens failed to improve the outcome of these patients. This study investigates a potential benefit from escalation of the WBRT dose beyond the "standard" regimen 30 Gy in 10 fractions (10x3 Gy).
Data from 51 melanoma patients receiving WBRT alone were retrospectively analyzed. A dosage of 10x3 Gy (n = 33) was compared with higher doses including 40 Gy/20 fractions (n = 11) and 45 Gy/15 fractions (n = 7) for survival (OS) and local (intracerebral) control (LC). Additional potential prognostic factors were evaluated: age, gender, performance status, number of metastases, extracerebral metastases, and recursive partitioning analysis (RPA) class.
At 6 months, OS rates were 27% after 10x3 Gy and 50% after higher doses (p = 0.009). The OS rates at 12 months were 4% and 20%. On multivariate analysis, higher WBRT doses (p = 0.010), fewer than four brain metastases (p = 0.012), no extracerebral metastases (p = 0.006), and RPA class 1 (p = 0.005) were associated with improved OS. The LC rates at 6 months were 23% after 10x3 Gy and 50% after higher doses (p = 0.021). The LC rates at 12 months were 0% and 13%. On multivariate analysis, higher WBRT doses (p = 0.020) and fewer than brain metastases (p = 0.002) were associated with better LC.
Given the limitations of a retrospective study, the findings suggest that patients with brain metastases from melanoma receiving WBRT alone may benefit from dose escalation beyond 10x3 Gy. The hypothesis generated by this study must be confirmed in a randomized trial stratifying for significant prognostic factors.
大多数黑色素瘤脑转移患者接受全脑放疗（WBRT）。然而，结果并不理想。分次放疗方案未能改善这些患者的预后。本研究旨在探讨将 WBRT 剂量从“标准”方案 30Gy/10 次（10x3Gy）提高到更高剂量是否有益。
回顾性分析了 51 例单独接受 WBRT 的黑色素瘤患者的数据。比较了 10x3Gy（n=33）与更高剂量（包括 40Gy/20 次（n=11）和 45Gy/15 次（n=7））的生存（OS）和局部（颅内）控制（LC）。评估了其他潜在的预后因素：年龄、性别、表现状态、转移灶数量、颅外转移灶和递归分区分析（RPA）分级。
6 个月时，10x3Gy 后 OS 率为 27%，高剂量组为 50%（p=0.009）。12 个月时 OS 率分别为 4%和 20%。多因素分析显示，更高的 WBRT 剂量（p=0.010）、少于 4 个脑转移灶（p=0.012）、无颅外转移灶（p=0.006）和 RPA 分级 1（p=0.005）与 OS 改善相关。6 个月时 10x3Gy 后 LC 率为 23%，高剂量组为 50%（p=0.021）。12 个月时 LC 率分别为 0%和 13%。多因素分析显示，更高的 WBRT 剂量（p=0.020）和脑转移灶较少（p=0.002）与 LC 更好相关。
鉴于回顾性研究的局限性，本研究结果提示，接受单纯 WBRT 的黑色素瘤脑转移患者可能受益于 10x3Gy 以上的剂量升级。这项研究提出的假设必须在分层考虑显著预后因素的随机试验中得到证实。
