Patel Kirtesh R, Burri Stuart H, Boselli Danielle, Symanowski James T, Asher Anthony L, Sumrall Ashley, Fraser Robert W, Press Robert H, Zhong Jim, Cassidy Richard J, Olson Jeffrey J, Curran Walter J, Shu Hui-Kuo G, Crocker Ian R, Prabhu Roshan S
Department of Radiation Oncology, Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Room AT225, Atlanta, GA, 30322, USA.
Southeast Radiation Oncology Group, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA.
J Neurooncol. 2017 Feb;131(3):611-618. doi: 10.1007/s11060-016-2334-3. Epub 2016 Dec 20.
Pre-operative stereotactic radiosurgery (pre-SRS) has been shown as a viable treatment option for resectable brain metastases (BM). The aim of this study is to compare oncologic outcomes and toxicities for pre-SRS and post-operative WBRT (post-WBRT) for resectable BM. We reviewed records of consecutive patients who underwent resection of BM and either pre-SRS or post-WBRT between 2005 and 2013 at two institutions. Overall survival (OS) was calculated using the Kaplan-Meier method. Cumulative incidence was used for intracranial outcomes. Multivariate analysis (MVA) was performed using the Cox and Fine and Gray models, respectively. Overall, 102 patients underwent surgical resection of BM; 66 patients with 71 lesions received pre-SRS while 36 patients with 42 cavities received post-WBRT. Baseline characteristics were similar except for the pre-SRS cohort having more single lesions (65.2% vs. 38.9%, p = 0.001) and smaller median lesion volume (8.3 cc vs. 15.3 cc, p = 0.006). 1-year OS was similar between cohorts (58% vs. 56%, respectively) (p = 0.43). Intracranial outcomes were also similar (2-year outcomes, pre-SRS vs. post-WBRT): local recurrence: 24.5% vs. 25% (p = 0.81), distant brain failure (DBF): 53.2% vs. 45% (p = 0.66), and leptomeningeal disease (LMD) recurrence: 3.5% vs. 9.0% (p = 0.66). On MVA, radiation cohort was not independently associated with OS or any intracranial outcome. Crude rates of symptomatic radiation necrosis were 5.6 and 0%, respectively. OS and intracranial outcomes were similar for patients treated with pre-SRS or post-WBRT for resected BM. Pre-SRS is a viable alternative to post-WBRT for resected BM. Further confirmatory studies with neuro-cognitive outcomes comparing these two treatment paradigms are needed.
术前立体定向放射外科治疗(pre-SRS)已被证明是可切除脑转移瘤(BM)的一种可行治疗选择。本研究的目的是比较可切除BM的pre-SRS和术后全脑放疗(post-WBRT)的肿瘤学结局和毒性。我们回顾了2005年至2013年期间在两家机构接受BM切除及pre-SRS或post-WBRT的连续患者的记录。采用Kaplan-Meier方法计算总生存期(OS)。累积发病率用于颅内结局。分别使用Cox模型和Fine and Gray模型进行多变量分析(MVA)。总体而言,102例患者接受了BM手术切除;66例患者的71个病灶接受了pre-SRS,而36例患者的42个病灶接受了post-WBRT。除pre-SRS队列有更多单发病灶(65.2%对38.9%,p = 0.001)和更小的中位病灶体积(8.3 cc对15.3 cc,p = 0.006)外,基线特征相似。队列间1年OS相似(分别为58%对56%)(p = 0.43)。颅内结局也相似(2年结局,pre-SRS对post-WBRT):局部复发:24.5%对25%(p = 0.81),远处脑衰竭(DBF):53.2%对45%(p = 0.66),以及软脑膜疾病(LMD)复发:3.5%对9.0%(p = 0.66)。在MVA中,放疗队列与OS或任何颅内结局无独立相关性。有症状的放射性坏死的粗发病率分别为5.6%和0%。对于接受pre-SRS或post-WBRT治疗的可切除BM患者,OS和颅内结局相似。对于可切除BM,pre-SRS是post-WBRT的一种可行替代方案。需要进一步进行比较这两种治疗模式的神经认知结局的验证性研究。