Sanghvi Samrat M, Lischalk Jonathan W, Cai Ling, Collins Sean, Nair Mani, Collins Brain, Unger Keith
Georgetown University School of Medicine, Medical Dental Building, 3900 Reservoir Road, N.W, Washington DC, 20057, USA.
Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Lower Level Bles, 3800 Reservoir Road, N.W, Washington DC, 20007, USA.
Radiat Oncol. 2017 Feb 28;12(1):43. doi: 10.1186/s13014-017-0774-3.
BACKGROUND: Brain metastases of gastrointestinal origin are a rare occurrence. Radiation therapy (RT) in the form of stereotactic radiosurgery (SRS) or whole brain radiation therapy (WBRT) is an effective established treatment modality in either the definitive or adjuvant setting. The aim of this study is to assess the long-term clinical outcomes of patients with gastrointestinal (GI) brain metastases treated with SRS or WBRT. METHODS: In this single institutional retrospective review, we detail the outcomes of patients diagnosed with metastatic brain tumors from an adenocarcinoma gastrointestinal primary. Patients were treated using stereotactic radiosurgery or whole brain radiation therapy. Initial site control (defined as lesions visualized on imaging at time of treatment), new site control (defined as new intracranial lesions visualized on follow-up imaging), and overall survival were calculated using the Kaplan-Meier method. RESULTS: Thirty-three patients were treated from August 2008 to December 2015. Primary malignancy locations were as follows: 18 colon, 6 esophagus, 4 rectum, 5 other. Median total dose delivered was 25 Gy (18-35 Gy) in a median of 4 fractions for SRS and 30 Gy (10.8-40 Gy) in 10 fractions for WBRT. Crude initial site control at last radiographic follow-up was 64.3% after SRS and 41.7% after WBRT. Eleven of the 28 brain lesions (39.3%) treated with SRS had resection of the SRS-treated lesion prior to radiation therapy. Five of the twelve patients (41.7%) undergoing WBRT underwent cranial resection prior to radiation therapy. Crude new site control at last radiographic follow-up was 46.4% after SRS and 83.3% after WBRT. Kaplan-Meier analysis of overall survival did not show any statistically significant difference between WBRT and SRS (p = 0.424). Median overall survival for SRS patients was 5.2 months (0.5-57.5) and for WBRT patients 4.4 months (0-15). Kaplan-Meier analysis of new site control was significantly improved with WBRT versus SRS (p = 0.017). Total dose, treatment with WBRT, and active extracranial disease were statistically significant on multivariate analysis for new site control (p < 0.05). CONCLUSIONS: Survival and intracranial disease control are poor following RT for brain metastases from GI primaries. In this small series, outcomes are worse than published series for other primary malignancies metastatic to the brain and further research into methods of local control improvement is warranted. Future studies should explore the utility of dose escalation or radiosensitization in this patient population.
背景:胃肠道原发性脑转移瘤较为罕见。立体定向放射外科(SRS)或全脑放射治疗(WBRT)形式的放射治疗(RT)在根治性或辅助治疗中是一种有效的既定治疗方式。本研究的目的是评估接受SRS或WBRT治疗的胃肠道(GI)脑转移瘤患者的长期临床结局。 方法:在这项单机构回顾性研究中,我们详细阐述了诊断为源自胃肠道原发性腺癌的转移性脑肿瘤患者的结局。患者接受立体定向放射外科或全脑放射治疗。使用Kaplan-Meier方法计算初始部位控制(定义为治疗时影像学上可见的病变)、新部位控制(定义为随访影像学上可见的新颅内病变)和总生存期。 结果:2008年8月至2015年12月期间共治疗了33例患者。原发性恶性肿瘤部位如下:18例为结肠,6例为食管,4例为直肠,5例为其他。SRS的中位总剂量为25 Gy(18 - 35 Gy),中位分割次数为4次;WBRT的中位总剂量为30 Gy(10.8 - 40 Gy),分割次数为10次。在最后一次影像学随访时,SRS后的初始部位粗略控制率为64.3%,WBRT后为41.7%。接受SRS治疗的28个脑病变中有11个(39.3%)在放射治疗前切除了经SRS治疗的病变。接受WBRT的12例患者中有5例(41.7%)在放射治疗前行颅骨切除术。在最后一次影像学随访时,SRS后的新部位粗略控制率为46.4%,WBRT后为83.3%。WBRT和SRS的总生存期Kaplan-Meier分析未显示任何统计学上的显著差异(p = 0.424)。SRS患者的中位总生存期为5.2个月(0.5 - 57.5),WBRT患者为4.4个月(0 - 15)。新部位控制的Kaplan-Meier分析显示,WBRT与SRS相比有显著改善(p = 0.017)。在新部位控制的多因素分析中,总剂量、WBRT治疗和颅外活动性疾病具有统计学意义(p < 0.05)。 结论:胃肠道原发性脑转移瘤放疗后的生存和颅内疾病控制较差。在这个小系列研究中,结局比其他原发性恶性肿瘤脑转移的已发表系列更差,因此有必要进一步研究改善局部控制的方法。未来的研究应探索在该患者群体中增加剂量或放射增敏的效用。
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