多脑转移瘤行海马回避全脑放疗同步推量

Hippocampus-avoidance whole-brain radiation therapy with a simultaneous integrated boost for multiple brain metastases.

机构信息

Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

出版信息

Cancer. 2020 Jun 1;126(11):2694-2703. doi: 10.1002/cncr.32787. Epub 2020 Mar 6.

DOI:10.1002/cncr.32787

PMID:32142171

Abstract

BACKGROUND

The current study was aimed at investigating the feasibility of hippocampus-avoidance whole-brain radiation therapy with a simultaneous integrated boost (HA-WBRT+SIB) for metastases and at assessing tumor control in comparison with conventional whole-brain radiation therapy (WBRT) in patients with multiple brain metastases.

METHODS

Between August 2012 and December 2016, 66 patients were treated within a monocentric feasibility trial with HA-WBRT+SIB: hippocampus-avoidance WBRT (30 Gy in 12 fractions, dose to 98% of the hippocampal volume ≤ 9 Gy) and a simultaneous integrated boost (51 or 42 Gy in 12 fractions) for metastases/resection cavities. Intracranial tumor control, hippocampal failure, and survival were subsequently compared with a retrospective cohort treated with WBRT via propensity score matching analysis.

RESULTS

After 1:1 propensity score matching, there were 62 HA-WBRT+SIB patients and 62 WBRT patients. Local tumor control (LTC) of existing metastases was significantly higher after HA-WBRT+SIB (98% vs 82% at 1 year; P = .007), whereas distant intracranial tumor control was significantly higher after WBRT (82% vs 69% at 1 year; P = .016); this corresponded to higher biologically effective doses. Intracranial progression-free survival (PFS; 13.5 vs 6.4 months; P = .03) and overall survival (9.9 vs 6.2 months; P = .001) were significantly better in the HA-WBRT+SIB cohort. Four patients (6.5%) developed hippocampal metastases after hippocampus avoidance. The neurologic death rate after HA-WBRT+SIB was 27.4%.

CONCLUSIONS

HA-WBRT+SIB can be an efficient therapeutic option for patients with multiple brain metastases and is associated with improved LTC of existing metastases, higher intracranial PFS, a reduction of the neurologic death rate, and an acceptable risk of radiation necrosis. The therapy has the potential to prevent neurocognitive adverse effects, which will be further evaluated in the multicenter, phase 2 HIPPORAD trial.

摘要

背景

本研究旨在探讨海马回避全脑放疗联合同步推量（HA-WBRT+SIB）治疗多发脑转移瘤的可行性，并与常规全脑放疗（WBRT）对比评估肿瘤局部控制情况。

方法

2012 年 8 月至 2016 年 12 月，66 例患者在单中心可行性试验中接受 HA-WBRT+SIB 治疗：海马回避 WBRT（30 Gy 分 12 次，海马体积 98%受照剂量≤9 Gy）和同步推量（51 或 42 Gy 分 12 次）治疗转移灶/切除术腔。通过倾向性评分匹配分析，比较颅内肿瘤控制、海马功能失败和生存情况。

结果

1:1 倾向性评分匹配后，HA-WBRT+SIB 组 62 例，WBRT 组 62 例。HA-WBRT+SIB 治疗后现有转移灶的局部肿瘤控制（LTC）明显更高（1 年时为 98% vs 82%；P=0.007），而 WBRT 治疗后远处颅内肿瘤控制明显更高（1 年时为 82% vs 69%；P=0.016）；这与较高的生物有效剂量有关。HA-WBRT+SIB 组颅内无进展生存期（PFS；13.5 个月 vs 6.4 个月；P=0.03）和总生存期（OS；9.9 个月 vs 6.2 个月；P=0.001）明显更长。4 例（6.5%）患者在海马回避后出现海马转移。HA-WBRT+SIB 后神经死亡率为 27.4%。