一项配对分析，比较了有或没有立体定向增敏的全脑放疗对一至三个脑转移瘤患者的脑内控制和总生存期的影响。
A matched-pair analysis comparing whole-brain radiotherapy with and without a stereotactic boost for intracerebral control and overall survival in patients with one to three cerebral metastases.
作者信息
Rades Dirk, Janssen Stefan, Bajrovic Amira, Khoa Mai Trong, Veninga Theo, Schild Steven E
机构信息
Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany.
出版信息
Radiat Oncol. 2017 Apr 24;12(1):69. doi: 10.1186/s13014-017-0804-1.
BACKGROUND
Twelve years ago, a randomized trial demonstrated that a radiosurgery boost added to whole-brain radiotherapy (WBRT) improved intracerebral control (IC) in patients with one to three cerebral metastases. Overall survival (OS) was improved only in the subgroup of patients with a single metastasis but not in the entire cohort. The present study compared both regimens in a different scenario outside a randomized trial.
METHODS
A total of 252 patients with one to three cerebral metastases were included. Eighty-four patients receiving WBRT plus a planned stereotactic boost and 168 patients receiving WBRT alone were individually matched 1:2 for nine factors including fractionation of WBRT, age, gender, performance score, primary tumor, number of cerebral metastases, extracerebral metastases, recursive partitioning analysis class, and time between cancer diagnosis and WBRT. Each group of three patients was required to match for all nine factors. Both groups were compared for IC and OS.
RESULTS
IC rates at 6, 12, 18 and 24 months were 88, 71, 45 and 22% after WBRT plus stereotactic boost vs. 75, 48, 38 and 22% after WBRT alone (p = 0.005). OS rates at 6, 12, 18 and 24 months were 76, 53, 32 and 25% after WBRT plus stereotactic boost and 67, 45, 29 and 20% after WBRT alone (p = 0.10). In patients with a single lesion, OS rates were also not significantly different (p = 0.12).
CONCLUSIONS
Similar to the previous randomized trial from 2004, this matched-pair study showed that a stereotactic boost in addition to WBRT significantly improved IC but not OS.
背景
12年前，一项随机试验表明，对于有1至3个脑转移瘤的患者，在全脑放疗（WBRT）基础上加用立体定向放射外科强化治疗可改善脑内控制（IC）情况。仅在单个转移瘤患者亚组中总生存期（OS）得到改善，而在整个队列中未改善。本研究在随机试验之外的不同情况下比较了这两种治疗方案。
方法
共纳入252例有1至3个脑转移瘤的患者。84例接受WBRT加计划性立体定向强化治疗的患者与168例仅接受WBRT的患者按1:2的比例针对9个因素进行个体匹配，这些因素包括WBRT的分割方式、年龄、性别、体能状态评分、原发肿瘤、脑转移瘤数量、脑外转移瘤、递归分区分析类别以及癌症诊断与WBRT之间的时间。每组3例患者需在所有9个因素上匹配。比较两组的IC和OS情况。
结果
WBRT加立体定向强化治疗后6、12、18和24个月时的IC率分别为88%、71%、45%和22%，而单纯WBRT治疗后分别为75%、48%、38%和22%（p = 0.005）。WBRT加立体定向强化治疗后6、12、18和24个月时的OS率分别为76%、53%、32%和25%，单纯WBRT治疗后分别为67%、45%、29%和20%（p = 0.10）。在单个病灶患者中，OS率也无显著差异（p = 0.12）。
结论
与2004年之前的随机试验相似，这项配对研究表明，在WBRT基础上加用立体定向强化治疗可显著改善IC，但不能改善OS。
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