Rades Dirk, Hornung Dagmar, Blanck Oliver, Martens Kristina, Khoa Mai Trong, Trang Ngo Thuy, Hüppe Michael, Terheyden Patrick, Gliemroth Jan, Schild Steven E
Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
Strahlenther Onkol. 2014 Sep;190(9):786-91. doi: 10.1007/s00066-014-0625-1. Epub 2014 Mar 25.
Three doses were compared for local control of irradiated metastases, freedom from new brain metastases, and survival in patients receiving stereotactic radiosurgery (SRS) alone for one to three newly diagnosed brain metastases.
In all, 134 patients were assigned to three groups according to the SRS dose given to the margins of the lesions: 13-16 Gy (n = 33), 18 Gy (n = 18), and 20 Gy (n = 83). Additional potential prognostic factors were evaluated: age (≤ 60 vs. > 60 years), gender, Karnofsky Performance Scale score (70-80 vs. 90-100), tumor type (non-small-cell lung cancer vs. melanoma vs. others), number of brain metastases (1 vs. 2-3), lesion size (< 15 vs. ≥ 15 mm), extracranial metastases (no vs. yes), RPA class (1 vs. 2), and interval of cancer diagnosis to SRS (≤ 24 vs. > 24 months).
For 13-16 Gy, 18 Gy, and 20 Gy, the 1-year local control rates were 31, 65, and 79%, respectively (p < 0.001). The SRS dose maintained significance on multivariate analysis (risk ratio: 2.25; 95% confidence interval: 1.56-3.29; p < 0.001). On intergroup comparisons of local control, 20 Gy was superior to 13-16 Gy (p < 0.001) but not to 18 Gy (p = 0.12); 18 Gy showed a strong trend toward better local control when compared with 13-16 Gy (p = 0.059). Freedom from new brain metastases (p = 0.57) and survival (p = 0.15) were not associated with SRS dose in the univariate analysis.
SRS doses of 18 Gy and 20 Gy resulted in better local control than 13-16 Gy. However, 20 Gy and 18 Gy must be compared again in a larger cohort of patients. Freedom from new brain metastases and survival were not associated with SRS dose.
比较三种剂量用于接受立体定向放射外科治疗（SRS）的1至3个新诊断脑转移瘤患者的局部照射转移灶控制、预防新发脑转移以及生存情况。
总共134例患者根据给予病灶边缘的SRS剂量分为三组：13 - 16 Gy（n = 33）、18 Gy（n = 18）和20 Gy（n = 83）。评估了其他潜在的预后因素：年龄（≤60岁与>60岁）、性别、卡氏功能状态评分（70 - 80与90 - 100）、肿瘤类型（非小细胞肺癌与黑色素瘤与其他）、脑转移瘤数量（1个与2 - 3个）、病灶大小（<15 mm与≥15 mm）、颅外转移（无与有）、RPA分级（1级与2级）以及癌症诊断至SRS的间隔时间（≤24个月与>24个月）。
对于13 - 16 Gy、18 Gy和20 Gy，1年局部控制率分别为31%、65%和79%（p < 0.001）。SRS剂量在多变量分析中仍具有显著性（风险比：2.25；95%置信区间：1.56 - 3.29；p < 0.001）。在局部控制的组间比较中，20 Gy优于13 - 16 Gy（p < 0.001）但不优于18 Gy（p = 0.12）；与13 - 16 Gy相比，18 Gy显示出局部控制更好的强烈趋势（p = 0.059）。在单变量分析中，预防新发脑转移（p = 0.57）和生存（p = 0.15）与SRS剂量无关。
18 Gy和20 Gy的SRS剂量比13 - 16 Gy能带来更好的局部控制。然而，必须在更大的患者队列中再次比较20 Gy和18 Gy。预防新发脑转移和生存与SRS剂量无关。
