Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Neurooncol. 2019 Sep;144(2):343-350. doi: 10.1007/s11060-019-03233-9. Epub 2019 Jul 16.
Postoperative stereotactic radiosurgery (SRS) has been shown to establish local control in patients with resected brain metastases, yet its efficacy may be limited, particularly for resected lesions with large post-operative resection cavities. We describe the efficacy of postoperative fractionated stereotactic radiotherapy (FSRT) for local control in patients who have undergone resection for brain metastases.
In this retrospective cohort study, we analyzed patients who received FSRT for resected brain metastases in 3 or 5 fractions. Time to local recurrence was the primary endpoint in this study.
Sixty-seven patients (n = 29 female, n = 38 male) met study criteria for review. The median age of the cohort was 62 years (range 18-79 years). Median preoperative tumor volume was 11.1 cm (range 0.4-77.0 cm). The rate of local control was 91.0% at 6 months, 85.1% at 12 months, and 85.1% at 18 months. Estimates of freedom from local recurrence at 6 and 12 months were 90.9% and 84.3%, respectively. Higher biologically equivalent doses (BED10) were found to be predictive of longer freedom from local recurrence on univariate and multivariable analysis. Larger cavity volumes were found to correspond to longer time to local recurrence on univariate and multivariable analysis.
Our results suggest that postoperative FSRT may be an effective method for providing local control to the surgical bed in patients with resected brain metastases, particularly for larger tumors not amenable to conventional, single-fraction SRS. Additional prospective studies are needed to confirm these findings.
术后立体定向放射外科（SRS）已被证明可在接受脑转移瘤切除术的患者中建立局部控制，但它的疗效可能有限，尤其是对于术后切除腔较大的切除病变。我们描述了术后分割立体定向放疗（FSRT）对接受脑转移瘤切除术的患者局部控制的疗效。
在这项回顾性队列研究中，我们分析了接受 3 或 5 个分次 FSRT 的脑转移瘤切除术后患者。本研究的主要终点是局部复发时间。
67 例患者（女性 29 例，男性 38 例）符合研究纳入标准。队列的中位年龄为 62 岁（范围 18-79 岁）。术前肿瘤体积中位数为 11.1 cm³（范围 0.4-77.0 cm³）。6 个月时局部控制率为 91.0%，12 个月时为 85.1%，18 个月时为 85.1%。6 个月和 12 个月时无局部复发生存率分别为 90.9%和 84.3%。单变量和多变量分析发现，较高的生物等效剂量（BED10）与较长的无局部复发生存时间相关。单变量和多变量分析发现，较大的空洞体积与较长的局部复发时间相关。
我们的结果表明，术后 FSRT 可能是一种有效的方法，可在接受脑转移瘤切除术的患者中为手术床提供局部控制，尤其是对于不能进行常规单次 SRS 的较大肿瘤。需要进一步的前瞻性研究来证实这些发现。
