Zimmerman Amy L, Murphy Erin S, Suh John H, Vogelbaum Michael A, Barnett Gene H, Angelov Lilyana, Ahluwalia Manmeet, Reddy Chandana A, Chao Samuel T
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, OH, USA Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
Technol Cancer Res Treat. 2016 Feb;15(1):186-95. doi: 10.1177/1533034614568097. Epub 2015 Jan 28.
We report our series of patients with large brain metastases, >3 cm in diameter, who received stereotactic radiosurgery (SRS) as a component of their treatment, focusing on survival and intracranial recurrence rates.
The brain tumor database was queried for patients treated with SRS for large brain metastases. Local recurrence (LR) and distant brain recurrence (DBR) rates were calculated using cumulative incidence analysis, and overall survival (OS) was calculated using Kaplan-Meier analysis. Patients were classified into 1 of the 4 groups based on treatment strategy: SRS alone, surgery plus SRS, SRS plus whole-brain radiation therapy (WBRT), and salvage SRS from more remote WBRT and/or surgery.
A total of 153 patients with 164 lesions were evaluated. The SRS alone was the treatment approach in 62 lesions, surgery followed by SRS to the resection bed (S + SRS) in 33, SRS + WBRT in 19, and salvage SRS in 50. There was no statistically significant difference in OS between the 4 treatment groups (P = .06). Median survival was highest in patients receiving surgery + SRS (12.2 months) followed by SRS + WBRT (6.9 months), SRS alone (6.6 months), and salvage SRS (6.1 months). There was also no significant difference for LR rates between the groups at 12 months. No significant variables on univariate analysis were noted for LR. The 12-month DBR rates were highest in the S + SRS group (52%), followed by salvage SRS (31%), SRS alone (28%), and SRS + WBRT (13%; P = .03).
There were no significant predictors for local control. Keeping in mind that patient numbers in the SRS + WBRT group are small, the addition of WBRT to SRS did not appear to significantly improve survival or local control, supporting the delayed use of WBRT for some patients to prevent potential side effects provided regular imaging surveillance and salvage therapy are utilized. Prospective studies are needed to optimize SRS treatment regimens for patients with large brain metastases.
我们报告了一系列直径大于3 cm的大脑转移瘤患者，他们接受了立体定向放射外科治疗（SRS）作为其治疗的一部分，重点关注生存率和颅内复发率。
查询脑肿瘤数据库中接受SRS治疗的大脑转移瘤患者。使用累积发病率分析计算局部复发（LR）和远处脑复发（DBR）率，使用Kaplan-Meier分析计算总生存期（OS）。根据治疗策略将患者分为4组中的1组：单纯SRS、手术加SRS、SRS加全脑放疗（WBRT）以及从更远处的WBRT和/或手术挽救性SRS。
共评估了153例患者的164个病灶。单纯SRS治疗62个病灶，手术加切除床SRS（S + SRS）治疗33个病灶，SRS + WBRT治疗19个病灶，挽救性SRS治疗50个病灶。4个治疗组之间的OS无统计学显著差异（P = 0.）。接受手术 + SRS的患者中位生存期最高（12.2个月），其次是SRS + WBRT（6.9个月）、单纯SRS（6.6个月）和挽救性SRS（6.1个月）。12个月时各组之间的LR率也无显著差异。单因素分析未发现与LR相关的显著变量。12个月时DBR率在S + SRS组最高（52%），其次是挽救性SRS（31%）、单纯SRS（28%）和SRS + WBRT（13%；P = 0.）。
对于局部控制没有显著的预测因素。考虑到SRS + WBRT组的患者数量较少，在SRS基础上加用WBRT似乎并未显著提高生存率或局部控制率，这支持了在一些患者中延迟使用WBRT以预防潜在副作用，前提是进行定期影像学监测并采用挽救性治疗。需要进行前瞻性研究以优化大脑转移瘤患者的SRS治疗方案。
