Department of Radiation Oncology, University of Lubeck, Germany.
Int J Radiat Oncol Biol Phys. 2010 Oct 1;78(2):404-8. doi: 10.1016/j.ijrobp.2009.07.1717. Epub 2010 Feb 18.
Brain metastases in bladder cancer patients are extremely rare. Most patients with multiple lesions receive longer-course whole-brain radiotherapy (WBRT) with 10 × 3 Gy/2 weeks or 20 × 2 Gy/4 weeks. Because its radiosensitivity is relatively low, metastases from bladder cancer may be treated better with hypofractionated radiotherapy. This study compared short-course hypofractionated WBRT (5 × 4 Gy/1 week) to longer-course WBRT.
Data for 33 patients receiving WBRT alone for multiple brain metastases from transitional cell bladder carcinoma were retrospectively analyzed. Short-course WBRT with 5 × 4 Gy (n = 12 patients) was compared to longer-course WBRT with 10 × 3 Gy/20 × 2 Gy (n = 21 patients) for overall survival (OS) and local (intracerebral) control (LC). Five additional potential prognostic factors were investigated: age, gender, Karnofsky performance score (KPS), number of brain metastases, and extracranial metastases. The Bonferroni correction for multiple tests was used to adjust the p values derived from the multivariate analysis. p values of <0.025 were considered significant.
At 6 months, OS was 42% after 5 × 4 Gy and 24% after 10 × 3/20 × 2 Gy (p = 0.31). On univariate analysis, improved OS was associated with less than four brain metastases (p = 0.021) and almost associated with a lack of extracranial metastases (p = 0.057). On multivariate analysis, both factors were not significant. At 6 months, LC was 83% after 5 × 4 Gy and 27% after 10 × 3/20 × 2 Gy (p = 0.035). Improved LC was almost associated with a KPS of ≥70 (p = 0.051). On multivariate analysis, WBRT regimen was almost significant (p = 0.036). KPS showed a trend (p = 0.07).
Short-course WBRT with 5 × 4 Gy should be seriously considered for most patients with multiple brain metastases from bladder cancer, as it resulted in improved LC.
膀胱癌患者发生脑转移极为罕见。大多数多发转移患者接受全脑放疗（WBRT），疗程为 10×3Gy/2 周或 20×2Gy/4 周。由于膀胱癌转移瘤的放射敏感性相对较低，采用分割剂量放疗可能效果更好。本研究比较了短疗程分割 WBRT（5×4Gy/1 周）与长疗程 WBRT。
对 33 例接受单纯 WBRT 治疗的移行细胞膀胱癌脑多发转移患者的数据进行回顾性分析。将 5×4Gy（n=12 例）的短疗程 WBRT 与 10×3Gy/20×2Gy（n=21 例）的长疗程 WBRT 进行总生存（OS）和局部（颅内）控制（LC）比较。对 5 个潜在预后因素进行了研究：年龄、性别、卡氏功能状态评分（KPS）、脑转移瘤数量和颅外转移。采用 Bonferroni 校正多重检验，对多因素分析得出的 p 值进行调整。p 值<0.025 认为具有统计学意义。
6 个月时，5×4Gy 组的 OS 为 42%，10×3/20×2Gy 组为 24%（p=0.31）。单因素分析显示，OS 改善与脑转移瘤少于 4 个（p=0.021）和几乎没有颅外转移（p=0.057）有关。多因素分析时，两个因素均无统计学意义。6 个月时，5×4Gy 组的 LC 为 83%，10×3/20×2Gy 组为 27%（p=0.035）。LC 改善与 KPS≥70（p=0.051）几乎有关。多因素分析时，WBRT 方案具有显著相关性（p=0.036）。KPS 呈趋势（p=0.07）。
对于大多数膀胱癌脑多发转移患者，5×4Gy 的短疗程 WBRT 应认真考虑，因为它可改善 LC。
