Murray Louise, Menard Cynthia, Zadeh Gelareh, Au Karolyn, Bernstein Mark, Millar Barbara-Ann, Laperriere Normand, Chung Caroline
Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9 Canada.
Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, ON Canada.
J Radiat Oncol. 2017;6(1):21-30. doi: 10.1007/s13566-016-0281-4. Epub 2016 Oct 27.
The objective of this study was to investigate outcomes for patients with brainstem metastases treated with stereotactic radiosurgery (SRS).
Patients with brainstem metastases treated with SRS between April 2006 and June 2012 were identified from a prospective database. Patient and treatment-related factors were recorded. Kaplan-Meier analysis was used to calculate survival and freedom from local and distant brain progression. Univariate and multivariate Cox regression was used to identify factors important for overall survival.
In total, 44 patients received SRS for 48 brainstem metastases of whom 33 (75 %) also received whole brain radiotherapy (WBRT): 23 patients (52 %) WBRT prior to SRS, 6 (13.6 %) WBRT concurrently with SRS and 4 (9.0 %) WBRT after SRS. Eight patients received a second course of WBRT at further progression. Median target volume was 1.33 cc (range 0.04-12.17) and median prescribed marginal dose was 15 Gy (range 10-22). There were four cases of local failure, and 6-month and 1-year freedom from local failure was 84.6 and 76.9 %, respectively. Median overall survival (OS) was 5.4 months. There were four cases of radionecrosis, 2 (4.8 %) of which were symptomatic. The absence of external beam brain radiotherapy (predominantly WBRT) showed a trend towards improved OS on univariate analysis. Neither local nor distant brain failure significantly impacted OS.
This retrospective series of patients treated with SRS for brainstem metastases, largely in combination with at least one course of WBRT, demonstrates that this approach is safe and results in good local control. In this cohort, no variables significantly impacted OS, including intracranial control.
本研究的目的是调查接受立体定向放射外科治疗（SRS）的脑干转移瘤患者的治疗结果。
从一个前瞻性数据库中识别出2006年4月至2012年6月期间接受SRS治疗的脑干转移瘤患者。记录患者及与治疗相关的因素。采用Kaplan-Meier分析计算生存率以及局部和远处脑转移进展的无进展生存期。使用单因素和多因素Cox回归分析确定对总生存期重要的因素。
共有44例患者因48个脑干转移瘤接受了SRS治疗，其中33例（75%）还接受了全脑放疗（WBRT）：23例患者（52%）在SRS之前接受了WBRT，6例（13.6%）在SRS同时接受了WBRT，4例（9.0%）在SRS之后接受了WBRT。8例患者在病情进一步进展时接受了第二疗程的WBRT。中位靶体积为1.33立方厘米（范围0.04 - 12.17），中位处方边缘剂量为15 Gy（范围10 - 22）。有4例局部复发，6个月和1年的局部无复发生存率分别为84.6%和76.9%。中位总生存期（OS）为5.4个月。有4例放射性坏死，其中2例（4.8%）出现症状。单因素分析显示，未接受外照射脑部放疗（主要是WBRT）有总生存期改善的趋势。局部或远处脑转移均未对总生存期产生显著影响。
这一回顾性系列接受SRS治疗的脑干转移瘤患者，大多联合了至少一个疗程的WBRT，表明该方法安全且能实现良好的局部控制。在该队列中，没有变量对总生存期产生显著影响，包括颅内控制情况。
