Radiation Oncology Department, Département de l'Imagerie Médical et Science de l'Information (DIMSI), Geneva University Hospital/University of Geneva, CH-1211 Geneva 14, Switzerland.
Radiat Oncol. 2011 Jun 30;6:79. doi: 10.1186/1748-717X-6-79.
To assess treatment toxicity and patients' survival/quality of life (QoL) after volumetric modulated arc therapy (VMAT) with simultaneous in-field boost (SIB) for cancer patients with 1 - 4 brain metastases (BM) treated with or without surgery.
Between March and December 2010, 29 BM patients (total volume BM, < 40 cm3) aged < 80 years, KPS ≥ 70, RPA < III were included in this prospective trial. Whole brain VMAT (30 Gy) and a SIB to the BM (40 Gy) was delivered in 10 fraction. Mean age was 62.1 ± 8.5 years. Fifteen (51.7%) underwent surgery. KPS and MMSE were prospectively assessed. A self-assessed questionnaire was used to assess the QoL (EORTC QLQ-C30 with -BN20 module).
As of April 2011 and after a mean FU of 5.4 ± 2.8 months, 14 (48.3%) patients died. The 6-month overall survival was 55.1%. Alopecia was only observed in 9 (31%) patients. In 3-month survivors, KPS was significantly (p = 0.01) decreased. MMSE score remained however stable (p = 0.33). Overall, QoL did decrease after VMAT. The mean QLQ-C30 global health status (p = 0.72) and emotional functional (p = 0.91) scores were decreased (low QoL). Physical (p = 0.05) and role functioning score (p = 0.01) were significantly worse and rapidly decreased during treatment. The majority of BN20 domains and single items worsened 3 months after VMAT except headaches (p = 0.046) and bladder control (p = 0.26) which improved.
The delivery of 40 Gy in 10 fractions to 1 - 4 BM using VMAT was achieved with no significant toxicity. QoL, performance status, but not MMSE, was however compromised 3 months after treatment in this selected cohort of BM patients.
评估容积旋转调强弧形治疗（VMAT）联合术中瘤床推量（SIB）治疗 1-4 个脑转移瘤（BM）的患者的毒性反应和生存质量（QoL），这些患者或手术或不手术。
2010 年 3 月至 12 月，29 名 BM 患者（总 BM 体积<40cm3，年龄<80 岁，KPS≥70，RPA<III）参与了这项前瞻性试验。全脑 VMAT（30Gy）和 BM 的 SIB（40Gy），共 10 个分次。平均年龄为 62.1±8.5 岁。其中 15 名患者（51.7%）接受了手术。KPS 和 MMSE 进行了前瞻性评估。采用自我评估问卷评估 QoL（EORTC QLQ-C30 与 BN20 模块）。
截至 2011 年 4 月，中位随访时间为 5.4±2.8 个月，14 名患者（48.3%）死亡。6 个月的总生存率为 55.1%。只有 9 名患者（31%）出现脱发。在 3 个月存活者中，KPS 显著降低（p=0.01）。然而，MMSE 评分保持稳定（p=0.33）。总的来说，VMAT 后 QoL 下降。QLQ-C30 全球健康状况（p=0.72）和情绪功能（p=0.91）评分下降（QoL 低）。躯体功能（p=0.05）和角色功能评分（p=0.01）在治疗期间显著下降。大多数 BN20 领域和单项在 VMAT 后 3 个月恶化，除头痛（p=0.046）和膀胱控制（p=0.26）外，这些指标在 VMAT 后 3 个月有所改善。
使用 VMAT 对 1-4 个 BM 进行 40Gy/10f 的分割照射未出现显著毒性反应。然而，在这个选择的 BM 患者队列中，3 个月后的 QoL、体能状态，但不是 MMSE，都受到了影响。
