立体定向放射外科治疗 1-4 个对放疗抵抗的脑转移瘤患者。
Stereotactic radiosurgery alone for patients with 1-4 radioresistant brain metastases.
机构信息
Department of Radiation Oncology, Arthur G. James Cancer Hospital, Ohio State University Medical Center, 300 West 10th Avenue, Ste 088A, Columbus, OH 43210, USA.
出版信息
Med Oncol. 2011 Dec;28 Suppl 1:S439-44. doi: 10.1007/s12032-010-9670-5. Epub 2010 Sep 3.
Brain metastases from radioresistant histologies are perceived to be less responsive to WBRT compared to other histologies, and stereotactic radiosurgery (SRS) may provide better local control. The aim of this study was to examine the outcomes of patients with 1-4 brain metastasis from radioresistant histologies (renal cell carcinoma and melanoma) treated with SRS alone. Thirty-eight patients with 1-4 radioresistant brain metastases (66 lesions) were treated with SRS alone. The median age was 55 years. Fourteen and 24 patients had renal cell carcinoma (RCC) and melanoma brain metastases, respectively. Distribution of number of lesions was as follows: one lesion, 22 patients; 2 lesions, 8 patients; 3 lesions, 5 patients; and 4 lesions, 3 patients. Distribution of RTOG recursive partitioning analysis (RPA) classes was as follows: II, 37 patients and III, 1 patient. The median marginal dose was 20 Gy. The median follow-up was 6.1 months. The 3-, 6-, 9-, 12-, and 18-month local control (LC) rates were 87.9, 81.4, 67.9, 67.9, and 60.3%, respectively. The corresponding free-from-distant-brain failure (FFDBF) rates were 71.3, 58.1, 49.8, 40.2, and 27.6%. The corresponding progression-free survival (PFS) rates were 55.3, 41.9, 33, 23.3, and 13.3%. RCC histology was associated with better LC (P = 0.0055). Although SRS alone could yield reasonable LC in patients with 1-4 radioresistant brain metastases, the risk of distant brain failure was substantial. The approach of routine omission of WBRT outside of a trial setting should be used judiciously.
从放射抗拒组织发生的脑转移瘤被认为对 WBRT 的反应性低于其他组织学类型，而立体定向放射外科（SRS）可能提供更好的局部控制。本研究旨在检查单独接受 SRS 治疗的 1-4 个放射抗拒性脑转移瘤（肾细胞癌和黑色素瘤）患者的治疗结果。38 例 1-4 个放射抗拒性脑转移瘤（66 个病灶）患者单独接受 SRS 治疗。中位年龄为 55 岁。14 例和 24 例患者分别患有肾细胞癌（RCC）和黑色素瘤脑转移瘤。病变数量分布如下：1 个病变 22 例，2 个病变 8 例，3 个病变 5 例，4 个病变 3 例。RTOG 递归分区分析（RPA）分类分布如下：II 级 37 例，III 级 1 例。边缘剂量中位数为 20Gy。中位随访时间为 6.1 个月。3、6、9、12 和 18 个月局部控制率（LC）分别为 87.9%、81.4%、67.9%、67.9%和 60.3%，相应的无远处脑失败率（FFDBF）分别为 71.3%、58.1%、49.8%、40.2%和 27.6%。相应的无进展生存率（PFS）分别为 55.3%、41.9%、33%、23.3%和 13.3%。RCC 组织学与更好的 LC 相关（P=0.0055）。虽然单独 SRS 治疗可使 1-4 个放射抗拒性脑转移瘤患者获得合理的 LC，但远处脑失败的风险仍然很大。在非试验环境下，应谨慎采用常规省略 WBRT 的方法。
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