Department of Radiation Oncology, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
University Hospital Freiburg, Freiburg, Germany.
J Neurosurg Sci. 2024 Feb;68(1):22-30. doi: 10.23736/S0390-5616.20.04830-4. Epub 2020 Feb 4.
Postoperative stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hFSRT) to tumor cavities is emerging as a new standard of care after resection of brain metastases. Both Gamma Knife (GK) and CyberKnife (CK) are modalities commonly used for stereotactic radiotherapy, but fractional schemes are not consistent. The objective of this study was to evaluate outcomes in patients receiving postoperative stereotactic radiotherapy of resected brain metastases (BM) using different fractionation schedules and modalities in two large centers.
Patients with newly diagnosed BM who underwent postoperative SRS or hFSRT with either GK or CK at two large cancer centers were retrospectively evaluated. We analyzed local control (LC), regional control (RC) and overall survival (OS).
From April 14 to May 18, 2020, 79 patients with 81 resection cavities were treated. Forty-seven patients (59.5%) received GK and 32 patients (40.5%) received CK treatment. Fifty-four cavities (66.7%) were treated with hFSRT and 27 (33.3%) with SRS. The most common hFSRT and SRS scheme was 3x10 Gy and 1x16 Gy, respectively. Median OS was 11.7 months with survival rates of 44.7% at 1 year and 18.5% at 2 years. LC was 83.3% after 1 year. Median time to regional progression was 12.0 months with RC rates of 61.1% at 6 months and 41.0% at 12 months. There was no difference in OS, LC or RC between GK and CK treatments or SRS and hFSRT.
Both SRS and hFSRT provide high local control rates in resected BM regardless of the applied modality.
术后立体定向放射外科（SRS）和低分割立体定向放疗（hFSRT）已成为脑转移瘤切除术后的新治疗标准。伽玛刀（GK）和 CyberKnife（CK）都是常用于立体定向放疗的模式，但分割方案并不一致。本研究旨在评估在两个大型中心使用不同分割方案和模式对切除的脑转移瘤（BM）进行术后立体定向放疗的患者的结果。
回顾性分析了在两个大型癌症中心接受术后 SRS 或 hFSRT 的新诊断为 BM 的患者。我们分析了局部控制（LC）、区域控制（RC）和总生存（OS）。
2020 年 4 月 14 日至 5 月 18 日，共 79 例患者的 81 个切除腔接受治疗。47 例（59.5%）接受 GK 治疗，32 例（40.5%）接受 CK 治疗。54 个（66.7%）切除腔接受 hFSRT 治疗，27 个（33.3%）接受 SRS 治疗。最常见的 hFSRT 和 SRS 方案分别为 3x10Gy 和 1x16Gy。中位 OS 为 11.7 个月，1 年生存率为 44.7%，2 年生存率为 18.5%。1 年后 LC 为 83.3%。中位区域进展时间为 12.0 个月，6 个月时 RC 率为 61.1%，12 个月时 RC 率为 41.0%。GK 和 CK 治疗或 SRS 和 hFSRT 之间的 OS、LC 或 RC 无差异。
无论应用何种模式，SRS 和 hFSRT 均可为切除的 BM 提供较高的局部控制率。
