Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.
Medical Analysis Laboratory, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy.
Clin Exp Metastasis. 2020 Feb;37(1):77-83. doi: 10.1007/s10585-019-10004-3. Epub 2019 Nov 6.
Stereotactic radiosurgery (SRS) is an effective treatment option for multiple brain metastases (BMs). Modern mono-isocentric techniques allow the delivery of multiple stereotactic courses, in the event of intracranial failure. Nevertheless, limited data on effectiveness and toxicity have been reported in comparison to WBRT. Aim of this retrospective matched-pair analysis was to compare patients affected by limited BMs treated with multiple SRS courses using a mono-isocentric, non-coplanar technique (HyperArc™, Varian Medical System) to upfront WBRT. One hundred and two patients accounting for 677 BMs were treated with HyperArc™. In case of further intracranial progression, 44 treatment courses of 201 metastases in 19 patients, were treated by subsequent HyperArc™ courses. This population was matched with 38 patients treated with WBRT. The median BMs number was 4 (range 2-10) for HyperArc™ and 5 (range 2-10) for WBRT. Overall survival (OS) and toxicity were evaluated. The median follow-up was 9 months (range 3-40 months). The median OS was not reached (range 5-22 months) for HyperArc™ patients and 8 months (range 3-40 months) for WBRT patients, while the 1-year OS was 77% and 34.6% for HyperArc™ and WBRT, respectively (p = 0.001; HR 4.77, 95% CI 1.62-14.00). There was one case of radionecrosis. HyperArc™ is an effective and safe technique for the treatment of multiple BMs. In selected cases of intracranial oligorecurrence, further subsequent courses can be safely delivered with the same technical approach. Moreover, in patients with a limited number of BMs, SRS showed an improved survival outcome when compared to WBRT.
立体定向放射外科(SRS)是治疗多发性脑转移瘤(BMs)的有效治疗选择。现代单等中心技术允许在颅内失败的情况下提供多次立体定向治疗。然而,与 WBRT 相比,其有效性和毒性的数据有限。本回顾性配对分析的目的是比较使用单等中心、非共面技术(Varian Medical System 的 HyperArc™)治疗局限性 BMs 的患者,这些患者接受了多次 SRS 治疗,而不是采用 WBRT。102 名患者(677 个 BM)接受了 HyperArc™治疗。如果颅内进一步进展,19 名患者中有 201 个转移灶的 44 个治疗疗程随后接受了 HyperArc™治疗。该人群与 38 名接受 WBRT 治疗的患者相匹配。HyperArc™的 BM 中位数为 4(范围 2-10),WBRT 的 BM 中位数为 5(范围 2-10)。评估了总生存期(OS)和毒性。中位随访时间为 9 个月(范围 3-40 个月)。HyperArc™患者的中位 OS 未达到(范围 5-22 个月),WBRT 患者为 8 个月(范围 3-40 个月),1 年 OS 分别为 HyperArc™和 WBRT 的 77%和 34.6%(p=0.001;HR 4.77,95%CI 1.62-14.00)。有 1 例放射性坏死。HyperArc™是治疗多发性 BMs 的有效且安全的技术。在颅内寡复发的情况下,可使用相同的技术方法安全地提供进一步的后续治疗。此外,对于 BM 数量有限的患者,与 WBRT 相比,SRS 显示出更好的生存结果。
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