Minniti Giuseppe, Scaringi Claudia, Paolini Sergio, Lanzetta Gaetano, Romano Andrea, Cicone Francesco, Osti Mattia, Enrici Riccardo Maurizi, Esposito Vincenzo
Unit of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
Unit of Radiation Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Int J Radiat Oncol Biol Phys. 2016 Jul 15;95(4):1142-8. doi: 10.1016/j.ijrobp.2016.03.013. Epub 2016 Mar 19.
To investigate the local control and radiation-induced brain necrosis in patients with brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of brain radionecrosis were assessed.
Two hundred eighty-nine consecutive patients with brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed. Cumulative incidence analysis was used to compare local control and radiation-induced brain necrosis between groups from the time of SRS. To achieve a balanced distribution of baseline covariates between treatment groups, a propensity score analysis was used.
The 1-year cumulative local control rates were 77% in the single-fraction SRS (SF-SRS) group and 91% in the multifraction SRS (MF-SRS) group (P=.01). Recurrences occurred in 25 and 11 patients who received SF-SRS or MF-SRS (P=.03), respectively. Thirty-one patients (20%) undergoing SF-SRS and 11 (8%) subjected to MF-SRS experienced brain radionecrosis (P=.004); the 1-year cumulative incidence rate of radionecrosis was 18% and 9% (P=.01), respectively. Significant differences between the 2 groups in terms of local control and risk of radionecrosis were maintained after propensity score adjustment.
Multifraction SRS at a dose of 27 Gy in 3 daily fractions seems to be an effective treatment modality for large brain metastases, associated with better local control and a reduced risk of radiation-induced radionecrosis as compared with SF-SRS.
研究接受单次分割或多次分割立体定向放射外科治疗（SRS）的脑转移瘤直径>2 cm患者的局部控制情况及放射性脑坏死；评估与临床结局和放射性脑坏死发生相关的因素。
对意大利罗马萨皮恩扎大学圣安德烈亚医院连续289例接受SRS作为主要治疗的脑转移瘤直径>2.0 cm的患者进行分析。采用累积发病率分析比较SRS后各组间的局部控制情况和放射性脑坏死情况。为使治疗组间基线协变量分布均衡，采用倾向评分分析。
单次分割SRS（SF-SRS）组1年累积局部控制率为77%，多次分割SRS（MF-SRS）组为91%（P=0.01）。接受SF-SRS或MF-SRS治疗的患者分别有25例和11例出现复发（P=0.03）。接受SF-SRS治疗的31例患者（20%）和接受MF-SRS治疗的11例患者（8%）发生放射性脑坏死（P=0.004）；放射性脑坏死的1年累积发病率分别为18%和9%（P=0.01）。倾向评分调整后，两组在局部控制和放射性脑坏死风险方面仍存在显著差异。
与SF-SRS相比，3天内分3次给予27 Gy的多次分割SRS似乎是治疗大型脑转移瘤的有效治疗方式，局部控制更好，放射性脑坏死风险降低。
