Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
Department of Neuro-oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Neurooncol. 2019 May;142(3):523-528. doi: 10.1007/s11060-019-03123-0. Epub 2019 Feb 15.
The presence of brain metastases (BM) in patients with non-seminomatous germ cell tumor (NSGCT) is associated with poor prognosis. While radiation therapy (RT) is an important treatment for patients with NSGCT BM, there is a paucity of data on the optimal regimen. We sought to investigate the impact of RT on clinical outcomes in patients with NSGCT BM.
Patients with NSGCT BM who received RT at our institution from 2002 to 2017 were included. Sixty-three consecutive patients were identified. Clinical factors associated with intracranial control (ICC) and overall survival (OS) were evaluated using cox regression analysis and Kaplan Meier method.
Median age was 31 years and number of BM was three. Fifteen patients presented with BM at diagnosis, while 48 developed BM at a median time of 8.4 months from diagnosis. At a median follow-up of 3.6 years, ICC and OS were 39.7% and 30.1%. On multivariate analysis, ICC (hazard ratio [HR] = 0.93, p = 0.03) and OS (HR = 0.93, p = 0.005) were both significantly associated with biologically effective dose (BED) of RT. The 4-year OS of patients who received BED < 39Gy, 39 Gy, 40-50 Gy, and ≥ 50 Gy were 0%, 14.7%, 34.1%, and 70.0%, respectively. Patients who achieved ICC after RT were able to achieve long-term survival (4-year OS 68.1% vs. 0%, p < 0.0001).
Our data supports that a higher BED is required for durable ICC, and that ICC is needed for patients with NSGCT to achieve long-term survival. Prospective studies evaluating radiation dose-escalation for the treatment of NSGCT BM should be considered.
非精原细胞瘤生殖细胞肿瘤（NSGCT）患者出现脑转移（BM）与预后不良相关。虽然放射治疗（RT）是治疗 NSGCT BM 的重要手段，但关于最佳方案的数据却很少。我们旨在研究 RT 对 NSGCT BM 患者临床结局的影响。
纳入 2002 年至 2017 年在我院接受 RT 的 NSGCT BM 患者。共确定了 63 例连续患者。采用 Cox 回归分析和 Kaplan-Meier 方法评估与颅内控制（ICC）和总生存（OS）相关的临床因素。
中位年龄为 31 岁，脑转移灶数量为 3 个。15 例患者在诊断时出现 BM，48 例患者在诊断后中位时间 8.4 个月时出现 BM。中位随访 3.6 年后，ICC 和 OS 分别为 39.7%和 30.1%。多因素分析显示，ICC（风险比[HR] = 0.93，p = 0.03）和 OS（HR = 0.93，p = 0.005）均与 RT 的生物有效剂量（BED）显著相关。接受 BED<39Gy、39Gy、40-50Gy 和≥50Gy 的患者 4 年 OS 分别为 0%、14.7%、34.1%和 70.0%。RT 后 ICC 达标的患者能够获得长期生存（4 年 OS 为 68.1%与 0%，p<0.0001）。
我们的数据支持需要更高的 BED 以获得持久的 ICC，并且 ICC 是 NSGCT 患者实现长期生存所必需的。应考虑开展评估 NSGCT BM 放射剂量递增治疗的前瞻性研究。
