London Health Sciences Centre, London, Canada.
Radiother Oncol. 2013 Feb;106(2):206-9. doi: 10.1016/j.radonc.2012.10.014. Epub 2012 Dec 4.
To compare lesional stereotactic radiosurgery to whole brain (WBRT) radiotherapy with simultaneous in-field boost for brain metastases in terms of overall survival.
A retrospective review was performed on two institutional databases of 500 patients diagnosed with brain metastatic disease who received either stereotactic radiosurgery (SRS, n = 381) or whole brain with simultaneous in-field boost radiotherapy (SIB, n = 119), between 2002 and 2011. Propensity-score matching was utilized to obtain two groups with similar known prognostic factor characteristics. Kaplan-Meier and univariable/multivariable Cox modeling were conducted to assess the treatment impact on overall survival (OS).
Propensity-score matching created a matched cohort of 178 patients (89 SRS/SIB) with similar baseline characteristics. Multivariable analysis demonstrated that presence/absence of systemic metastases, patient age, tumor volume, and presence/absence of active primary were found to be more predictive of OS than treatment assignment (p = 0.38). SIB was associated with reduced intracranial failure likely due to the WBRT component of the treatment (HR 0.36, p<0.001).
Adjusting for other predictive factors, treatment with either SRS or SIB did not result in any statistically significant difference in OS; however, observed intracranial failure was different due to the use of WBRT in the SIB cohort.
比较立体定向放射外科（SRS）和全脑（WBRT）放疗联合局部推量治疗脑转移瘤患者的总生存情况。
回顾性分析了 2002 年至 2011 年间，500 例脑转移瘤患者分别接受 SRS（n = 381）或 WBRT 联合局部推量放疗（SIB，n = 119）的两个机构数据库。采用倾向评分匹配法获得两组具有相似已知预后因素特征的患者。采用 Kaplan-Meier 法和单变量/多变量 Cox 模型评估治疗对总生存（OS）的影响。
倾向评分匹配后得到了 178 例匹配患者（89 例 SRS/SIB），其基线特征相似。多变量分析表明，系统转移的存在与否、患者年龄、肿瘤体积以及原发灶的活动情况比治疗方案更能预测 OS（p = 0.38）。SIB 治疗组颅内失败率降低，可能与 WBRT 治疗部分有关（HR 0.36，p<0.001）。
在调整其他预测因素后，SRS 或 SIB 治疗方案在 OS 方面无显著差异；然而，由于 SIB 组使用了 WBRT，观察到的颅内失败情况有所不同。
