Sandler Kiri A, Shaverdian Narek, Cook Ryan R, Kishan Amar U, King Christopher R, Yang Isaac, Steinberg Michael L, Lee Percy
Department of Radiation Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California.
Cancer. 2017 Jun 15;123(12):2274-2282. doi: 10.1002/cncr.30607. Epub 2017 Feb 8.
Published guidelines regarding the optimal treatment strategies for brain metastases focus on patients with ≤3 lesions. As delivery techniques for stereotactic radiosurgery (SRS) improve, radiation oncologists are increasingly using it for patients with >3 metastases. In the current study, the authors sought to characterize practice patterns among practitioners to identify areas of controversy.
A survey of practicing radiation oncologists was distributed via e-mail. Responses were collected from April 1 to May 5, 2016. Survey data were analyzed.
A total of 711 currently practicing radiation oncologists responded, for a response rate of 12.5%. Specialists in central nervous system tumors (CNS specialists) were more likely to treat higher numbers of patients with brain metastases with SRS. There was a significant difference in the optimal "cutoff number" used when deciding how many lesions to treat with SRS versus whole-brain radiotherapy. Cutoff numbers were significantly higher for high-volume CNS specialists (≥10 patients/month) than for either low-volume CNS specialists (5-9 patients/month) or high-volume, non-CNS specialists (8.1 vs 5.6 and 5.1, respectively; P<.001). A majority of respondents (56%) identified patients with 4 to 6 brain metastases as being the most challenging patients to treat.
To the authors' knowledge, there appears to be no consensus regarding the optimal treatment strategy among patients with >3 brain metastases, and practice patterns are heterogeneous. Radiation oncologists, especially high-volume CNS specialists, are treating significantly more brain metastases with SRS than what currently is recommended by published consensus guidelines. Providers struggle with patients with a moderate intracranial disease burden. Further prospective studies are needed to support these practice patterns and guide decision making. Cancer 2017;123:2274-2282. © 2017 American Cancer Society.
已发表的关于脑转移瘤最佳治疗策略的指南主要关注病灶≤3个的患者。随着立体定向放射外科（SRS）技术的不断改进，放射肿瘤学家越来越多地将其用于治疗转移灶>3个的患者。在本研究中，作者试图描述从业者的实践模式，以确定存在争议的领域。
通过电子邮件向在职放射肿瘤学家进行调查。于2016年4月1日至5月5日收集回复。对调查数据进行分析。
共有711名在职放射肿瘤学家回复，回复率为12.5%。中枢神经系统肿瘤专家（CNS专家）更有可能用SRS治疗更多脑转移瘤患者。在决定用SRS治疗多少个病灶与全脑放疗时，所使用的最佳“临界值数量”存在显著差异。高工作量CNS专家（≥10例患者/月）的临界值数量显著高于低工作量CNS专家（5 - 9例患者/月）或高工作量非CNS专家（分别为8.1对5.6和5.1；P<.001）。大多数受访者（56%）认为有4至6个脑转移灶的患者是最难治疗的。
据作者所知，对于转移灶>3个的患者，最佳治疗策略似乎尚无共识，实践模式也各不相同。放射肿瘤学家，尤其是高工作量CNS专家，用SRS治疗的脑转移瘤患者数量明显多于目前已发表的共识指南所推荐的数量。医疗服务提供者在治疗颅内疾病负担中等的患者时面临困难。需要进一步的前瞻性研究来支持这些实践模式并指导决策。《癌症》2017年；123:2274 - 2282。©2017美国癌症协会
