Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2010 Oct 1;78(2):385-9. doi: 10.1016/j.ijrobp.2009.08.027. Epub 2010 Jan 25.
The authors investigated whether the addition of whole-brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) provided any therapeutic benefit according to recursive partitioning analysis (RPA) class.
Two hundred forty-five patients with 1 to 10 metastases who underwent SRS between January 2002 and December 2007 were included in the study. Of those, 168 patients were treated with SRS alone and 77 patients received SRS followed by WBRT. Actuarial curves were estimated using the Kaplan-Meier method regarding overall survival (OS), distant brain control (DC), and local brain control (LC) stratified by RPA class. Analyses for known prognostic variables were performed using the Cox proportional hazards model.
Univariate and multivariate analysis revealed that control of the primary tumor, small number of brain metastases, Karnofsky performance scale (KPS) > 70, and initial treatment modalities were significant predictors for survival. For RPA class 1, SRS plus WBRT was associated with a longer survival time compared with SRS alone (854 days vs. 426 days, p = 0.042). The SRS plus WBRT group also showed better LC rate than did the SRS-alone group (p = 0.021), although they did not show a better DC rate (p = 0.079). By contrast, for RPA class 2 or 3, no significant difference in OS, LC, or DC was found between the two groups.
These results suggest that RPA classification should determine whether or not WBRT is added to SRS. WBRT may be recommended to be added to SRS for patients in whom long-term survival is expected on the basis of RPA classification.
作者通过递归分区分析（RPA）对全脑放疗（WBRT）联合立体定向放疗（SRS）治疗 1 至 10 个脑转移瘤的疗效进行了研究。
本研究纳入了 2002 年 1 月至 2007 年 12 月期间接受 SRS 治疗的 245 例 1 至 10 个脑转移瘤患者。其中，168 例患者单纯接受 SRS 治疗，77 例患者接受 SRS 联合 WBRT。采用 Kaplan-Meier 法对 RPA 分级分层的总生存期（OS）、远处脑控制（DC）和局部脑控制（LC）进行评估。采用 Cox 比例风险模型对已知预后因素进行分析。
单因素和多因素分析显示，原发肿瘤控制情况、脑转移瘤数目较少、Karnofsky 表现状态（KPS）＞70 分和初始治疗方式是影响生存的重要因素。对于 RPA 分级 1 患者，SRS 联合 WBRT 组的生存时间长于单纯 SRS 组（854 天比 426 天，p=0.042）。SRS 联合 WBRT 组的 LC 率也高于单纯 SRS 组（p=0.021），尽管两组的 DC 率差异无统计学意义（p=0.079）。而对于 RPA 分级 2 或 3 的患者，两组之间的 OS、LC 或 DC 差异均无统计学意义。
这些结果表明，RPA 分级应决定是否联合 WBRT 治疗。根据 RPA 分级，对于预计生存时间较长的患者，可推荐 SRS 联合 WBRT。
