挽救性立体定向放射手术治疗脑转移瘤：患者选择中需要考虑的预后因素。
Salvage radiosurgery for brain metastases: prognostic factors to consider in patient selection.
机构信息
Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
出版信息
Int J Radiat Oncol Biol Phys. 2014 Jan 1;88(1):137-42. doi: 10.1016/j.ijrobp.2013.10.003.
PURPOSE
Stereotactic radiosurgery (SRS) is offered to patients for recurrent brain metastases after prior brain radiation therapy (RT), but few studies have evaluated the efficacy of salvage SRS or factors to consider in selecting patients for this treatment. This study reports overall survival (OS), intracranial progression-free survival (PFS), and local control (LC) after salvage SRS, and factors associated with outcomes.
METHODS AND MATERIALS
This is a retrospective review of patients treated from 2009 to 2011 with salvage SRS after prior brain RT for brain metastases. Survival from salvage SRS and from initial brain metastases diagnosis (IBMD) was calculated. Univariate and multivariable (MVA) analyses included age, performance status, recursive partitioning analysis (RPA) class, extracranial disease control, and time from initial RT to salvage SRS.
RESULTS
There were 106 patients included in the analysis with a median age of 56.9 years (range 32.5-82 years). A median of 2 metastases were treated per patient (range, 1-12) with a median dose of 21 Gy (range, 12-24) prescribed to the 50% isodose. With a median follow-up of 10.5 months (range, 0.1-68.2), LC was 82.8%, 60.1%, and 46.8% at 6 months, 1 year, and 3 years, respectively. Median PFS was 6.2 months (95% confidence interval [CI]=4.9-7.6). Median OS was 11.7 months (95% CI=8.1-13) from salvage SRS, and 22.1 months from IBMD (95% CI=18.4-26.8). On MVA, age (P=.01; hazard ratio [HR]=1.04; 95% CI=1.01-1.07), extracranial disease control (P=.004; HR=0.46; 95% CI=0.27-0.78), and interval from initial RT to salvage SRS of at least 265 days (P=.001; HR=2.46; 95% CI=1.47-4.09) were predictive of OS.
CONCLUSIONS
This study demonstrates that patients can have durable local control and survival after salvage SRS for recurrent brain metastases. In particular, younger patients with controlled extracranial disease and a durable response to initial brain RT are likely to benefit from salvage SRS.
目的
立体定向放射外科（SRS）为先前接受脑部放射治疗（RT）后复发脑转移的患者提供治疗，但很少有研究评估挽救性 SRS 的疗效或选择患者进行该治疗的考虑因素。本研究报告了挽救性 SRS 后的总生存（OS）、颅内无进展生存（PFS）和局部控制（LC），以及与结局相关的因素。
方法和材料
这是一项对 2009 年至 2011 年间接受挽救性 SRS 治疗的患者进行的回顾性研究，这些患者先前因脑转移而行脑部 RT 治疗。从挽救性 SRS 和初始脑转移诊断（IBMD）计算生存。单变量和多变量（MVA）分析包括年龄、表现状态、递归分区分析（RPA）分级、颅外疾病控制以及从初始 RT 到挽救性 SRS 的时间。
结果
分析中纳入了 106 例患者，中位年龄为 56.9 岁（范围 32.5-82 岁）。每位患者平均治疗 2 个转移灶（范围 1-12 个），每个转移灶的中位剂量为 21 Gy（范围 12-24），处方给 50%等剂量线。中位随访时间为 10.5 个月（范围 0.1-68.2），6 个月、1 年和 3 年时的 LC 分别为 82.8%、60.1%和 46.8%。中位 PFS 为 6.2 个月（95%置信区间[CI]=4.9-7.6）。从挽救性 SRS 开始，中位 OS 为 11.7 个月（95%CI=8.1-13），从 IBMD 开始为 22.1 个月（95%CI=18.4-26.8）。在 MVA 中，年龄（P=.01；风险比[HR]=1.04；95%CI=1.01-1.07）、颅外疾病控制（P=.004；HR=0.46；95%CI=0.27-0.78）和初始 RT 至挽救性 SRS 的时间间隔至少为 265 天（P=.001；HR=2.46；95%CI=1.47-4.09）是 OS 的预测因素。
结论
本研究表明，患者在复发脑转移后接受挽救性 SRS 治疗后，可获得持久的局部控制和生存。特别是年龄较小、颅外疾病得到控制且对初始脑 RT 有持久反应的患者可能从挽救性 SRS 中受益。
Zotero 插件