Department of Radiation Oncology, Medical Center, Medical Faculty, University of Freiburg, Freiburg im Breisgau, Germany.
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.
Cancer Med. 2018 Jun;7(6):2350-2359. doi: 10.1002/cam4.1486. Epub 2018 May 9.
In patients undergoing surgical resection of brain metastases, the risk of local recurrence remains high. Adjuvant whole brain radiation therapy (WBRT) can reduce the risk of local relapse but fails to improve overall survival. At two tertiary care centers in Germany, a retrospective study was performed to evaluate the role of hypofractionated stereotactic radiotherapy (HFSRT) in patients with brain metastases after surgical resection. In particular, need for salvage treatment, for example, WBRT, surgery, or stereotactic radiosurgery (SRS), was evaluated. Both intracranial local (LF) and locoregional (LRF) failures were analyzed. A total of 181 patients were treated with HFSRT of the surgical cavity. In addition to the assessment of local control and distant intracranial control, we analyzed treatment modalities for tumor recurrence including surgical strategies and reirradiation. Imaging follow-up for the evaluation of LF and LRF was available in 159 of 181 (88%) patients. A total of 100 of 159 (63%) patients showed intracranial progression after HFSRT. A total of 81 of 100 (81%) patients received salvage therapy. Fourteen of 81 patients underwent repeat surgery, and 78 of 81 patients received radiotherapy as a salvage treatment (53% WBRT). Patients with single or few metastases distant from the initial site or with WBRT in the past were retreated by HFSRT (14%) or SRS, 33%. Some patients developed up to four metachronous recurrences, which could be salvaged successfully. Eight (4%) patients experienced radionecrosis. No other severe side effects (CTCAE≥3) were observed. Postoperative HFSRT to the resection cavity resulted in a crude rate for local control of 80.5%. Salvage therapy for intracranial progression was commonly needed, typically at distant sites. Salvage therapy was performed with WBRT, SRS, and surgery or repeated HFSRT of the resection cavity depending on the tumor spread and underlying histology. Prospective studies are warranted to clarify whether or not the sequence of these therapies is important in terms of quality of life, risk of radiation necrosis, and likelihood of neurological cause of death.
在接受脑部转移瘤手术切除的患者中，局部复发的风险仍然很高。辅助全脑放疗（WBRT）可以降低局部复发的风险，但不能提高总生存率。在德国的两家三级护理中心，进行了一项回顾性研究，以评估立体定向放射外科（SRS）在脑部转移瘤切除术后患者中的作用。特别是，评估了挽救性治疗的需求，例如 WBRT、手术或 SRS。颅内局部（LF）和局部区域（LRF）失败均进行了分析。共对 181 例患者进行了手术腔的分次立体定向放射治疗（HFSRT）。除了评估局部控制和远处颅内控制外，我们还分析了肿瘤复发的治疗方式，包括手术策略和再放疗。对 181 例患者中的 159 例（88%）进行了 LF 和 LRF 的影像学随访。在 HFSRT 后，共 100 例患者（63%）颅内进展。共有 81 例患者接受了挽救性治疗。14 例患者接受了重复手术，78 例患者接受了放疗作为挽救性治疗（53%WBRT）。有单发或少数转移灶远离初始部位的患者，或既往接受过 WBRT 的患者，采用 HFSRT（14%）或 SRS（33%）进行再治疗。一些患者发生了多达四个的同步复发，但都得到了成功挽救。8 例（4%）患者出现放射性坏死。未观察到其他严重的不良反应（CTCAE≥3）。术后对手术切除腔进行 HFSRT 治疗，局部控制的粗略率为 80.5%。颅内进展需要进行常规挽救性治疗，通常发生在远处部位。根据肿瘤的播散和潜在的组织学，挽救性治疗采用 WBRT、SRS、手术或重复切除腔的 HFSRT。需要进行前瞻性研究，以明确这些治疗方法的顺序在生活质量、放射性坏死风险和神经源性死亡风险方面是否重要。
