全脑放疗后脑容量减少：定量评估与预后相关性。
Brain volume reduction after whole-brain radiotherapy: quantification and prognostic relevance.
机构信息
Department of Radiation Oncology, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany.
Department of Neuroradiology, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany.
出版信息
Neuro Oncol. 2018 Jan 22;20(2):268-278. doi: 10.1093/neuonc/nox150.
BACKGROUND
Recent studies have questioned the value of adding whole-brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) for brain metastasis treatment. Neurotoxicity, including radiation-induced brain volume reduction, could be one reason why not all patients benefit from the addition of WBRT. In this study, we quantified brain volume reduction after WBRT and assessed its prognostic significance.
METHODS
Brain volumes of 91 patients with cerebral metastases were measured during a 150-day period after commencing WBRT and were compared with their pretreatment volumes. The average daily relative change in brain volume of each patient, referred to as the "brain volume reduction rate," was calculated. Univariate and multivariate Cox regression analyses were performed to assess the prognostic significance of the brain volume reduction rate, as well as of 3 treatment-related and 9 pretreatment factors. A one-way analysis of variance was used to compare the brain volume reduction rate across recursive partitioning analysis (RPA) classes.
RESULTS
On multivariate Cox regression analysis, the brain volume reduction rate was a significant predictor of overall survival after WBRT (P < 0.001), as well as the number of brain metastases (P = 0.002) and age (P = 0.008). Patients with a relatively favorable prognosis (RPA classes 1 and 2) experienced significantly less brain volume decrease after WBRT than patients with a poor prognosis (RPA class 3) (P = 0.001). There was no significant correlation between delivered radiation dose and brain volume reduction rate (P = 0.147).
CONCLUSION
In this retrospective study, a smaller decrease in brain volume after WBRT was an independent predictor of longer overall survival.
背景
最近的研究对立体定向放射外科（SRS）治疗脑转移瘤时是否需要加用全脑放疗（WBRT）提出了质疑。神经毒性，包括放射性脑容积减少，可能是并非所有患者都从 WBRT 获益的原因之一。本研究定量分析了 WBRT 后脑容积减少，并评估其预后意义。
方法
91 例脑转移患者在 WBRT 开始后 150 天内进行脑容积测量，并与治疗前的脑容积进行比较。计算每位患者的脑容积平均每日相对变化率，即“脑容积减少率”。进行单因素和多因素 Cox 回归分析，以评估脑容积减少率以及 3 种治疗相关因素和 9 种治疗前因素的预后意义。采用单因素方差分析比较递归分区分析（RPA）各分级之间的脑容积减少率。
结果
多因素 Cox 回归分析显示，WBRT 后脑容积减少率是总生存的显著预测因子（P < 0.001），也是脑转移瘤数量（P = 0.002）和年龄（P = 0.008）的显著预测因子。预后较好（RPA 分级 1 和 2）的患者 WBRT 后脑容积减少明显低于预后较差（RPA 分级 3）的患者（P = 0.001）。脑容积减少率与所给放疗剂量之间无显著相关性（P = 0.147）。
结论
本回顾性研究表明，WBRT 后脑容积减少较少是总生存时间延长的独立预测因子。
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