Keller Audrey, Doré Mélanie, Cebula Hélène, Thillays François, Proust François, Darié Ioana, Martin Stéphane-André, Delpon Gregory, Lefebvre François, Noël Georges, Antoni Delphine
University Radiotherapy Department, Centre Paul-Strauss, Strasbourg, France.
Radiotherapy Department, Institut de Cancérologie de l'Ouest (ICO), Saint-Herblain, France.
Int J Radiat Oncol Biol Phys. 2017 Dec 1;99(5):1179-1189. doi: 10.1016/j.ijrobp.2017.08.014. Epub 2017 Aug 19.
To retrospectively report the outcomes of a large multicenter cohort of patients treated with surgery and hypofractionated stereotactic radiation therapy (HFSRT) to the resection cavities of brain metastases (BMs).
Between March 2008 and February 2015, 181 patients with no prior whole-brain radiation therapy (WBRT) were treated by HFSRT to the surgical bed of BM at the dose of 33 Gy (3 × 11 Gy). The primary endpoint was local control. Secondary endpoints were distant brain control, overall survival (OS), risk of radionecrosis, and leptomeningeal disease (LMD).
Of the 189 resected lesions, 44% were metastatic from a non-small cell lung cancer primary tumor, and 76% of patients had a single BM at the time of treatment. With a median follow-up of 15 months, the 6- and 12-month local control rates were 93% and 88%, respectively. On multivariate analysis, planning target volume (P=.005), graded prognostic assessment score (P=.021), and meningeal contact of BM (P=.032) were predictive of local failure. The 6- and 12-month distant brain control rates were 70% and 61%, respectively. Twenty-six patients (14%) developed signs of LMD at a median time of 3.8 months. The preoperative tumor volume was predictive of LMD (P=.029). The median OS was 17 months. The 6-, 12-, and 24-month OS rates were 79%, 62%, and 39%, respectively. Recursive partitioning analysis class 3 (P=.02), piecemeal resection (P=.017), and an increasing number of BMs (P<.01) were independent unfavorable prognostic factors for OS. Fifty-four patients (30%) were subsequently treated with salvage WBRT at a median time of 6.5 months, and 41% were reirradiated with SRT. Radionecrosis occurred in 19% of cases at a median time of 15 months and was associated with the infratentorial location of the BM (P=.0025).
This study demonstrated the safety and efficacy of a 3 × 11 Gy HFSRT regimen for the irradiation of BMs resection cavities. It was an alternative to adjuvant WBRT.
回顾性报告接受手术及大分割立体定向放射治疗（HFSRT）至脑转移瘤（BM）切除腔的大型多中心队列患者的治疗结果。
2008年3月至2015年2月期间，181例未曾接受过全脑放疗（WBRT）的患者接受了HFSRT治疗，照射剂量为33 Gy（3×11 Gy），照射部位为BM手术床。主要终点为局部控制。次要终点为远处脑转移控制、总生存期（OS）、放射性坏死风险及软脑膜疾病（LMD）。
在189个切除的病灶中，44%为非小细胞肺癌原发肿瘤转移灶，76%的患者在治疗时仅有单个BM。中位随访时间为15个月，6个月和12个月时的局部控制率分别为93%和88%。多因素分析显示，计划靶体积（P = 0.005）、分级预后评估评分（P = 0.021）及BM的脑膜侵犯（P = 0.032）可预测局部复发。6个月和12个月时的远处脑转移控制率分别为70%和61%。26例患者（14%）出现LMD体征，中位时间为3.8个月。术前肿瘤体积可预测LMD（P = 0.029）。中位OS为17个月。6个月、12个月和24个月时的OS率分别为79%、62%和39%。递归分割分析3级（P = 0.02）、分块切除（P = 0.017）及BM数量增加（P < 0.01）是OS的独立不良预后因素。54例患者（30%）随后接受了挽救性WBRT，中位时间为6.5个月，41%的患者接受了立体定向放射治疗（SRT）再程照射。19%的病例发生放射性坏死，中位时间为15个月，且与BM的幕下位置相关（P = 0.0025）。
本研究证明了3×11 Gy HFSRT方案照射BM切除腔的安全性和有效性。它是辅助WBRT的一种替代方案。
