一种用于预测未接受全脑放疗的伽玛刀立体定向放射外科治疗患者远处脑功能衰竭的列线图。
A nomogram for predicting distant brain failure in patients treated with gamma knife stereotactic radiosurgery without whole brain radiotherapy.
作者信息
Ayala-Peacock Diandra N, Peiffer Ann M, Lucas John T, Isom Scott, Kuremsky J Griff, Urbanic James J, Bourland J Daniel, Laxton Adrian W, Tatter Stephen B, Shaw Edward G, Chan Michael D
机构信息
Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (D.N.A.-P., A.M.P., J.T.L., J.G.K., J.J.U., J.D.B., E.G.S., M.D.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (A.W.L., S.B.T.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.I.); Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina (A.M.P., J.D.B., A.W.L., S.B.T., E.G.S., M.D.C.).
出版信息
Neuro Oncol. 2014 Sep;16(9):1283-8. doi: 10.1093/neuonc/nou018. Epub 2014 Feb 20.
BACKGROUND
We review our single institution experience to determine predictive factors for early and delayed distant brain failure (DBF) after radiosurgery without whole brain radiotherapy (WBRT) for brain metastases.
MATERIALS AND METHODS
Between January 2000 and December 2010, a total of 464 patients were treated with Gamma Knife stereotactic radiosurgery (SRS) without WBRT for primary management of newly diagnosed brain metastases. Histology, systemic disease, RPA class, and number of metastases were evaluated as possible predictors of DBF rate. DBF rates were determined by serial MRI. Kaplan-Meier method was used to estimate rate of DBF. Multivariate analysis was performed using Cox Proportional Hazard regression.
RESULTS
Median number of lesions treated was 1 (range 1-13). Median time to DBF was 4.9 months. Twenty-seven percent of patients ultimately required WBRT with median time to WBRT of 5.6 months. Progressive systemic disease (χ(2)= 16.748, P < .001), number of metastases at SRS (χ(2) = 27.216, P < .001), discovery of new metastases at time of SRS (χ(2) = 9.197, P < .01), and histology (χ(2) = 12.819, P < .07) were factors that predicted for earlier time to distant failure. High risk histologic subtypes (melanoma, her2 negative breast, χ(2) = 11.020, P < .001) and low risk subtypes (her2 + breast, χ(2) = 11.343, P < .001) were identified. Progressive systemic disease (χ(2) = 9.549, P < .01), number of brain metastases (χ(2) = 16.953, P < .001), minimum SRS dose (χ(2) = 21.609, P < .001), and widespread metastatic disease (χ(2) = 29.396, P < .001) were predictive of shorter time to WBRT.
CONCLUSION
Systemic disease, number of metastases, and histology are factors that predict distant failure rate after primary radiosurgical management of brain metastases.
背景
我们回顾了我们单一机构的经验，以确定在未进行全脑放疗（WBRT）的情况下，脑转移瘤立体定向放射外科治疗后早期和延迟远处脑衰竭（DBF）的预测因素。
材料与方法
2000年1月至2010年12月期间，共有464例患者接受了伽玛刀立体定向放射外科治疗（SRS），未进行WBRT，用于新诊断脑转移瘤的初始治疗。评估组织学、全身疾病、RPA分级和转移灶数量作为DBF发生率的可能预测因素。通过系列MRI确定DBF发生率。采用Kaplan-Meier方法估计DBF发生率。使用Cox比例风险回归进行多变量分析。
结果
治疗的病灶中位数为1个（范围1-13个）。发生DBF的中位时间为4.9个月。27%的患者最终需要进行WBRT，进行WBRT的中位时间为5.6个月。进行性全身疾病（χ(2)= 16.748，P <.001）、SRS时的转移灶数量（χ(2) = 27.216，P <.001）、SRS时发现新的转移灶（χ(2) = 9.197，P <.01）和组织学（χ(2) = 12.819，P <.07）是预测远处失败较早时间的因素。确定了高风险组织学亚型（黑色素瘤、her2阴性乳腺癌，χ(2) = 11.020，P <.001）和低风险亚型（her2 +乳腺癌，χ(2) = 11.343，P <.001）。进行性全身疾病（χ(2) = 9.549，P <.01）、脑转移瘤数量（χ(2) = 16.953，P <.001）、SRS最小剂量（χ(2) = 21.609，P <.001）和广泛转移疾病（χ(2) = 29.396，P <.0
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