Scharp Maike, Hauswald Henrik, Bischof Marc, Debus Juergen, Combs Stephanie E
Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany.
Radiat Oncol. 2014 Jan 3;9:4. doi: 10.1186/1748-717X-9-4.
Goal of this retrospective analysis was to evaluate the role of repeat whole brain radiotherapy in the palliative care of patients with brain metastases due to solid tumors.
Data regarding demographic data, primary tumor, metastasis, radiotherapy and symptoms were compiled on 134 patients with cerebral metastases that received repeat whole brain radiotherapy (WBRT) in our clinic between 2002 and 2011.
The analyzed group consisted of 63 (47%) women and 71 (53%) men with a median age of 57 at the start of re-irradiation. Most frequent primary site was the lung (87%).Sixty patients with lung cancer received the first WBRT prophylactically. At the time of re-WBRT 81% of all patients suffered from additional extracerebral metastases.Time between first and second WBRT was a median of 13.4 months. Full dose for the first WBRT was 30 Gy in 2.0 Gy single dose, for the second 20 Gy in 2.0 Gy single dose.At the start of the Re-WBRT 81 patients (60.4%) had mild, 32 (23.9%) severe neurological symptoms, 21 patients (15.7%) were asymptomatic. The median Karnofsky performance status was 70%. Overall, re-WBRT was tolerated satisfactorily. Main side effects were fatigue, erythema and focal alopecia, 10% of patients discontinued treatment before reaching the planned dose. Median survival was 2.8 months since the end of the re-WBRT with good performance status at the start of the re-irradiation being a key indicator for longer survival.Fifty-two patients (39%) showed a clinical improvement of neurological symptoms after the therapy, 59 patients (44%) remained stable, 23 patients (17%) showed worse symptoms.
From this large patient collective we were able to show that re-WBRT can be an important therapeutic option with low rate of acute side effects for patients in adequate general condition.
本回顾性分析的目的是评估重复全脑放疗在实体瘤脑转移患者姑息治疗中的作用。
收集了2002年至2011年间在我院接受重复全脑放疗（WBRT）的134例脑转移患者的人口统计学数据、原发肿瘤、转移情况、放疗及症状等资料。
分析组包括63例（47%）女性和71例（53%）男性，再次放疗开始时的中位年龄为57岁。最常见的原发部位是肺（87%）。60例肺癌患者接受了首次预防性WBRT。再次WBRT时，81%的患者伴有其他脑外转移。首次和第二次WBRT之间的时间中位数为13.4个月。首次WBRT的全量为30 Gy，分2.0 Gy单次剂量；第二次为20 Gy，分2.0 Gy单次剂量。再次WBRT开始时，81例患者（60.4%）有轻度、32例患者（23.9%）有重度神经症状，21例患者（15.7%）无症状。卡氏功能状态中位值为70%。总体而言，再次WBRT耐受性良好。主要副作用为疲劳、红斑和局灶性脱发，10%的患者在达到计划剂量前停止治疗。自再次WBRT结束后的中位生存期为2.8个月，再次放疗开始时功能状态良好是生存期较长的关键指标。52例患者（39%）治疗后神经症状有临床改善，59例患者（44%）症状稳定，23例患者（17%）症状恶化。
从这个大型患者群体中我们能够表明，对于一般状况良好的患者，再次WBRT可以是一种重要的治疗选择，急性副作用发生率低。
