Wagner Aaron E, Chen Andy, Anker Christopher J, Tward Jonathan D, Ghia Amol J, Jensen Randy L, Shrieve Dennis C
Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA (author has since relocated to the Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA).
J Radiosurg SBRT. 2014;3(2):111-121.
Stereotactic radiosurgery (SRS) is well established in the treatment of brain metastases, however it's exact role remains unclear. A single metastasis at presentation raises additional challenges, however there is minimal outcome data within this subgroup. We sought to evaluate the outcomes of treatment in patients with a single brain metastasis, as well as factors impacting local control.
All patients treated with SRS for a single brain metastasis were evaluated. Data was collected regarding patient demographics, treatment characteristics, and treatment outcomes. Univariate analyses were performed to evaluate the impact of treatment and patient variables on these outcomes. Emphasis was placed on analyses of factors impacting LC.
Between 1998 and 2011, a total of 141 patients underwent SRS for a single brain metastasis; in addition 31 had surgical resection, 15 received whole brain radiotherapy (WBRT), and 2 underwent both. There was no statistical impact on local control (LC) or distant intracranial control (DIC) with the addition of WBRT or surgery (LC 74%, 100%, and 58%, and DIC 37%, 67%, and 49% for SRS alone, SRS + WBRT, and SRS + surgery, respectively, smallest p = 0.17). Local control was decreased with larger tumors, doses <20Gy, and tight overtreatment ratios (i.e. conformity) (largest p = 0.02), although the independence of these factors could not be established. Long term freedom from requiring future whole brain radiotherapy was 73%.
SRS alone for patients with single brain metastases demonstrates acceptable intracranial outcomes. Further evaluation into factors impacting LC are warranted.
立体定向放射外科治疗（SRS）在脑转移瘤的治疗中已得到广泛应用，但其确切作用仍不明确。初诊时为单个转移瘤会带来额外挑战，然而该亚组的疗效数据极少。我们旨在评估单个脑转移瘤患者的治疗效果以及影响局部控制的因素。
对所有接受SRS治疗单个脑转移瘤的患者进行评估。收集有关患者人口统计学、治疗特征和治疗结果的数据。进行单因素分析以评估治疗和患者变量对这些结果的影响。重点分析影响局部控制的因素。
1998年至2011年间，共有141例患者接受了SRS治疗单个脑转移瘤；此外，31例接受了手术切除，15例接受了全脑放疗（WBRT），2例同时接受了这两种治疗。添加WBRT或手术对局部控制（LC）或远处颅内控制（DIC）无统计学影响（单独SRS、SRS + WBRT和SRS +手术的LC分别为74%、100%和58%，DIC分别为37%、67%和49%，最小p = 0.17）。肿瘤较大、剂量<20Gy和紧密的过度治疗率（即适形度）会降低局部控制率（最大p = 0.02），尽管这些因素的独立性无法确定。长期无需未来全脑放疗的自由度为73%。
对于单个脑转移瘤患者，单独使用SRS显示出可接受的颅内治疗效果。有必要进一步评估影响局部控制的因素。
