Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA.
Cancer. 2013 Jan 1;119(1):226-32. doi: 10.1002/cncr.27504. Epub 2012 Jun 15.
As systemic therapies improve and patients live longer, concerns mount about the toxicity of whole-brain radiation therapy (WBRT) for treatment of brain metastases. Development of delayed white matter abnormalities indicative of leukoencephalopathy have been correlated with cognitive dysfunction. This study assesses the risk of imaging-defined leukoencephalopathy in patients whose management included WBRT in addition to stereotactic radiosurgery (SRS). This risk is compared to patients who only underwent SRS.
We retrospectively compared 37 patients with non-small cell lung cancer who underwent WBRT plus SRS to 31 patients who underwent only SRS. All patients survived at least 1 year after treatment. We graded the development of delayed white matter changes on magnetic resonance imaging using a scale to evaluate T(2) /FLAIR (fluid attenuated image recovery) images: grade 1 = little or no white matter hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity.
Patients treated with WBRT and SRS had a significantly greater incidence of delayed white matter leukoencephalopathy compared to patients who underwent SRS alone (P < .001). On final imaging, 36 of 37 patients (97.3%) treated by WBRT developed leukoencephalopathy (25% with grade 2; 70.8% with grade 3). Only 1 patient treated with SRS alone developed leukoencephalopathy.
Risk of leukoencephalopathy in patients treated with SRS alone for brain metastases was significantly lower than that for patients treated with WBRT plus SRS. A prospective study is necessary to correlate these findings with neurocognition and quality of life. These data supplement existing reports regarding the differential effects of WBRT and SRS on normal brain structure and function.
随着全身治疗的进展和患者生存期的延长，人们越来越关注全脑放疗（WBRT）治疗脑转移瘤的毒性。延迟性白质异常的发展表明存在白质脑病，并与认知功能障碍相关。本研究评估了接受 WBRT 联合立体定向放射外科（SRS）治疗的患者与仅接受 SRS 治疗的患者中影像学定义的白质脑病的风险。将这两种风险与仅接受 SRS 治疗的患者进行了比较。
我们回顾性比较了 37 例接受 WBRT 联合 SRS 治疗的非小细胞肺癌患者和 31 例仅接受 SRS 治疗的患者。所有患者在治疗后至少存活 1 年。我们使用评估 T2/FLAIR（液体衰减反转恢复）图像的评分系统来评估磁共振成像上延迟性白质变化的发展：1 级=白质高信号很少或没有；2 级=局限性脑室周围高信号；3 级=弥漫性白质高信号。
与仅接受 SRS 治疗的患者相比，接受 WBRT 和 SRS 联合治疗的患者发生延迟性白质脑病的发生率显著更高（P<0.001）。在最终的影像学检查中，接受 WBRT 治疗的 37 例患者中有 36 例（97.3%）出现白质脑病（25%为 2 级；70.8%为 3 级）。仅 1 例单独接受 SRS 治疗的患者出现白质脑病。
接受 SRS 单独治疗脑转移瘤的患者发生白质脑病的风险明显低于接受 WBRT 联合 SRS 治疗的患者。需要进行前瞻性研究以将这些发现与神经认知和生活质量相关联。这些数据补充了关于 WBRT 和 SRS 对正常大脑结构和功能的不同影响的现有报告。
