Maranzano Ernesto, Terenzi Sara, Anselmo Paola, Casale Michelina, Arcidiacono Fabio, Loreti Fabio, Di Marzo Alessandro, Draghini Lorena, Italiani Marco, Trippa Fabio
Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy.
Nuclear Medicine Service, "S. Maria" Hospital, Terni, Italy.
Clin Transl Radiat Oncol. 2019 Apr 13;17:1-6. doi: 10.1016/j.ctro.2019.04.003. eCollection 2019 Jul.
In our previous published trial on radiosurgery (SRS) of recurrent brain metastases (BM) after whole brain radiotherapy (WBRT), Karnofsky performance status (KPS) and administered dose conditioned outcome and late toxicity, respectively. Brain radionecrosis was registered in 6% of patients. With the aim to obtain similar satisfactory outcomes and limit toxicity, we started a phase II trial in which reirradiation of BM with SRS were done using a tighter patient selection.
Patients with BM recurring after WBRT were recruited for reirradiation with SRS. Only patients with good KPS (≥70), good neurologic functional score (NFS 0-1) and lesions with a diameter ≤20 mm were considered eligible for retreatment. Dose exceeding 20 Gy was never administered.
The 59 patients reirradiated had 109 BM with a diameter range of 6-20 mm. Median interval between prior WBRT and SRS was 15 months and median SRS administered dose was 18 Gy (range 10-20 Gy). Complete and partial response (CR, PR) was obtained in 42% of patients with 2 years of control rate of 81%. Median overall survival (OS) after reirradiation was 14 months. No radionecrosis was detected.
Analysis of our current trial compared with results of our previous data suggests that a tighter patient selection (KPS ≥ 70; NFS 0-1, BM with ≤20 mm of diameter) and SRS dose ≤20 Gy allowed a high OS rate, a good percentage of CR and PR which last for >2 years, and no brain radionecrosis.
在我们之前发表的关于全脑放疗（WBRT）后复发性脑转移瘤（BM）的立体定向放射外科治疗（SRS）试验中，卡氏功能状态评分（KPS）和给予的剂量分别决定了疗效和晚期毒性。6%的患者出现了放射性脑坏死。为了获得相似的满意疗效并限制毒性，我们开展了一项II期试验，在该试验中对BM进行再照射时采用了更严格的患者选择标准。
招募WBRT后复发的BM患者进行SRS再照射。仅KPS良好（≥70）、神经功能评分良好（NFS 0 - 1）且直径≤20毫米的病灶患者被认为适合再次治疗。从未给予超过20 Gy的剂量。
59例接受再照射的患者有109个BM，直径范围为6 - 20毫米。先前WBRT与SRS之间的中位间隔时间为15个月，SRS给予的中位剂量为18 Gy（范围10 - 20 Gy）。42%的患者获得完全缓解和部分缓解（CR，PR），2年控制率为81%。再照射后的中位总生存期（OS）为14个月。未检测到放射性坏死。
将我们当前试验的分析结果与之前的数据结果进行比较表明，更严格的患者选择标准（KPS≥70；NFS 0 - 1，直径≤20毫米的BM）以及SRS剂量≤20 Gy可实现较高的OS率、较高比例的CR和PR且持续时间>2年，并且无放射性脑坏死。
