Department of Radiation Oncology, University Hospital Schleswig-Holstein, Lübeck, Germany.
Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Strahlenther Onkol. 2010 Feb;186(2):70-75. doi: 10.1007/s00066-010-2067-8. Epub 2010 Jan 26.
Whole-brain radiotherapy (WBRT) alone is the most common treatment for brain metastases from colorectal cancer, as most patients are not candidates for more aggressive therapies such as resection or radiosurgery. The standard WBRT regimen, 30 Gy in ten fractions (10 x 3 Gy), has generally resulted in poor outcomes. This study investigated whether an escalation of the WBRT dose improves these results.
Data from 53 patients receiving WBRT alone for brain metastases from colorectal cancer were retrospectively analyzed. 10 x 3 Gy (n = 35) was compared to higher doses (40 Gy/20 fractions or 45 Gy/15 fractions; n = 18) for overall survival (OS) and local control (LC). Additional factors evaluated for prognostic importance included age, gender, performance status, number of metastases, and extracerebral metastases.
The OS rates at 6 months were 17% after 10 x 3 Gy and 50% after 20 x 2 Gy/15 x 3 Gy (p = 0.014). On multivariate analysis, improved OS was significantly associated with higher WBRT dose (p = 0.047), Karnofsky Performance Score (KPS) > or = 70 (p = 0.034), less than four brain metastases (p = 0.036), and lack of extracerebral metastases (p = 0.010). The LC rates at 6 months were 17% after 10 x 3 Gy and 50% after higher doses (p = 0.018). On multivariate analysis of LC, higher WBRT dose was significant (p = 0.028). A trend was observed for KPS > or = 70 (p = 0.08) and less than four brain metastases (p = 0.06).
These data suggest that patients with brain metastases from colorectal cancer treated with WBRT alone appeared to benefit from escalation of the radiation dose beyond 10 x 3 Gy in terms of improved OS and LC.
全脑放疗（WBRT）是结直肠癌脑转移的最常见治疗方法，因为大多数患者不符合更积极的治疗方法（如切除术或放射外科手术）的条件。标准的 WBRT 方案为 30 Gy 分 10 次（10×3 Gy），但总体结果较差。本研究旨在探讨提高 WBRT 剂量是否能改善这些结果。
回顾性分析了 53 例接受单纯 WBRT 治疗的结直肠癌脑转移患者的数据。将 10×3 Gy（n=35）与较高剂量（40 Gy/20 次或 45 Gy/15 次；n=18）进行比较，以评估总生存期（OS）和局部控制（LC）。评估了其他预后重要因素，包括年龄、性别、表现状态、转移灶数量和脑外转移。
10×3 Gy 组的 6 个月 OS 率为 17%，20×2 Gy/15×3 Gy 组为 50%（p=0.014）。多变量分析显示，OS 改善与较高的 WBRT 剂量显著相关（p=0.047），Karnofsky 表现状态评分（KPS）≥70（p=0.034），脑转移灶少于 4 个（p=0.036），无脑外转移（p=0.010）。10×3 Gy 组的 6 个月 LC 率为 17%，较高剂量组为 50%（p=0.018）。多变量分析显示，较高的 WBRT 剂量与 LC 显著相关（p=0.028）。KPS≥70（p=0.08）和脑转移灶少于 4 个（p=0.06）有趋势。
这些数据表明，接受单纯 WBRT 治疗的结直肠癌脑转移患者似乎从 WBRT 剂量的增加中获益，提高了 OS 和 LC。
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