Feuvret L, Vinchon S, Martin V, Lamproglou I, Halley A, Calugaru V, Chea M, Valéry C A, Simon J-M, Mazeron J-J
Centre des tumeurs, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Centre Paul-Papin, 2, rue Moll, 49100 Angers cedex, France.
Cancer Radiother. 2014 Mar;18(2):97-106. doi: 10.1016/j.canrad.2013.12.003. Epub 2014 Jan 14.
To assess effectiveness and toxicity levels of stereotactic radiation therapy without whole brain radiation therapy in patients with solitary brain metastases larger than 3cm.
Between June 2007 and March 2009, 12 patients received fractionated stereotactic radiation therapy and 24 patients underwent stereotactic radiosurgery. For the fractionated stereotactic radiation therapy group, 3×7.7Gy were delivered to the planning target volume (PTV); median volume and diameter were 29.4 cm(3) and 4.4cm, respectively. For the stereotactic radiosurgery group, 14Gy were delivered to the PTV; median volume and diameter were 15.6 cm(3) and 3.7cm, respectively.
Median follow-up was 218 days. For the fractionated stereotactic radiation therapy group, local control rates were 100% at 360 days and 64% at 720 days; for the stereotactic radiosurgery group, rates were 58% at 360 days and 48% at 720 days (P=0.06). Median survival time was 504 days for the fractionated stereotactic radiation therapy group and 164 days for the stereotactic radiosurgery group (P=0.049). Two cases of grade 2 toxicity were observed in the fractionated stereotactic radiation therapy group, and 6 cases of grade 1-2 toxicity, in the stereotactic radiosurgery group.
This study provides data to support that fractionated stereotactic radiation therapy without whole brain radiation therapy with a margin dose of 3 fractions of 7.7Gy for treatment of solitary large brain metastases is efficient and well-tolerated. Because of the significant improvement in overall survival, this schedule should be assessed in a randomized trial.
评估对于直径大于3cm的孤立性脑转移瘤患者，不进行全脑放射治疗的立体定向放射治疗的有效性和毒性水平。
2007年6月至2009年3月期间，12例患者接受了分次立体定向放射治疗，24例患者接受了立体定向放射外科治疗。对于分次立体定向放射治疗组，向计划靶体积（PTV）给予3×7.7Gy的剂量；中位体积和直径分别为29.4cm³和4.4cm。对于立体定向放射外科治疗组，向PTV给予14Gy的剂量；中位体积和直径分别为15.6cm³和3.7cm。
中位随访时间为218天。对于分次立体定向放射治疗组，360天时局部控制率为100%，720天时为64%；对于立体定向放射外科治疗组，360天时为58%，720天时为48%（P=0.06）。分次立体定向放射治疗组的中位生存时间为504天，立体定向放射外科治疗组为164天（P=0.049）。在分次立体定向放射治疗组中观察到2例2级毒性反应，在立体定向放射外科治疗组中观察到6例1 - 2级毒性反应。
本研究提供的数据支持，对于孤立性大的脑转移瘤，不进行全脑放射治疗，采用边缘剂量为3次7.7Gy的分次立体定向放射治疗是有效且耐受性良好的。由于总生存期有显著改善，应在随机试验中评估该方案。
