Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
Clin Exp Metastasis. 2020 Apr;37(2):353-363. doi: 10.1007/s10585-020-10022-6. Epub 2020 Feb 1.
The role of radiosurgery has become further accentuated in the era of targeted agents (TA). Thus, the neurologic outcome of radiosurgery in brain metastasis (BM) of non-small cell lung cancer (NSCLC) was reviewed. We analyzed 135 patients with BM of NSCLC who were administered Cyberknife radiosurgery (CKRS) as either initial or salvage therapy. We evaluated local failure (LF), intracranial failure (IF), and neurological death (ND) due to BM. Primary outcome was neurological death-free survival (NDFS). Median follow-up was 16.2 months. Median CKRS dose of 22 Gy was administered to median 2 targets per patient. Among 99 deaths, 14 (14%) were ND. Upfront treatment for BM included CKRS alone in 85 patients (63%), CKRS + TA in 26 patients (19%), and WBRT in 24 patients (18%). No patients or tumor related factors were associated with ND. However, the type of upfront treatment for BM was significantly associated with ND [HR 0.07 (95% CI 0.01-0.57) for CKRS + TA, HR 0.56 (95% CI 0.19-1.68) for CKRS alone] compared with the WBRT group (P = 0.01). The 2-year NDFS rates for the CKRS + TA, CRKS alone, and WBRT groups were 94%, 87%, and 78%, respectively (P = 0.03). Upfront CKRS showed significantly higher 2-year LF-free survival rate (P < 0.01). IF rate was insignificantly lower in the WBRT group compared with CKRS group (P = 0.38). Upfront CKRS + TA was associated with the best neurological outcome with high NDFS. Active brain control by early delivery of radiosurgery could achieve better neurological outcome in NSCLC with BM.
在靶向治疗（TA）时代，放射外科的作用进一步凸显。因此，我们回顾了非小细胞肺癌（NSCLC）脑转移（BM）患者接受放射外科治疗后的神经学结果。我们分析了 135 例接受 Cyberknife 放射外科治疗（CKRS）作为初始或挽救治疗的 BM 患者。我们评估了局部失败（LF）、颅内失败（IF）和 BM 导致的神经死亡（ND）。主要结果是无神经死亡生存（NDFS）。中位随访时间为 16.2 个月。中位 CKRS 剂量为 22Gy，每个患者治疗 2 个靶区。在 99 例死亡中，14 例（14%）为 ND。BM 的一线治疗包括 CKRS 单独治疗 85 例（63%）、CKRS+TA 治疗 26 例（19%）和 WBRT 治疗 24 例（18%）。患者或肿瘤相关因素均与 ND 无关。然而，BM 的一线治疗类型与 ND 显著相关[CKRS+TA 组的 HR 为 0.07（95%CI 0.01-0.57），CKRS 组的 HR 为 0.56（95%CI 0.19-1.68）]与 WBRT 组相比（P=0.01）。CKRS+TA、CKRS 单独和 WBRT 组的 2 年 NDFS 率分别为 94%、87%和 78%（P=0.03）。CKRS 单独治疗组的 2 年 LF 无失败生存率显著更高（P<0.01）。WBRT 组 IF 率与 CKRS 组相比无显著差异（P=0.38）。CKRS+TA 作为一线治疗与最佳神经学结果相关，NDFS 较高。早期放射外科治疗积极控制脑转移可改善 NSCLC 脑转移患者的神经学结局。
