Radiotherapy Department, Centre Paul Strauss, Strasbourg Cedex, 67065, France.
Public Health and Statistics Department, Centre Paul Strauss, Strasbourg Cedex, 67065, France.
Clin Exp Metastasis. 2020 Jun;37(3):425-434. doi: 10.1007/s10585-020-10031-5. Epub 2020 Mar 17.
To compare the local control and brain radionecrosis in patients with brain metastasis primarily treated by single-fraction radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). Between January 2012 and December 2017, 179 patients with only 1-3 brain metastases (total: 287) primarily treated by SRS (14 Gy) or HFSRT (23.1 Gy in 3 fractions of 7.7 Gy, every other day) were retrospectively analyzed in a single center. Follow-up imaging data were available in 152 patients with 246 lesions. The corresponding Biological Effective Dose (BED) were 33.6 Gy and 40.9 Gy respectively for SRS and HFSRT group, assuming an α/β of 10 Gy. Local control (LC) and risk of radionecrosis (RN) were calculated by the Kaplan-Meier method. The actuarial local control rates at 6 and 12 months were 94% and 88.1% in SRS group, and 87.6% and 78.4%, in HFSRT group (p = 0.06), respectively. Only the total volume of edema was associated with worse LC (p = 0.01, HR 1.02, 95% CI [1.004-1.03]) in multivariate analysis. Brain radionecrosis occurred in 1 lesion in SRS group and 9 in HFSRT group. Median time to necrosis was 5.5 months (range 1-9). Only the volume of GTV was associated with RN (p = 0.02, HR 1.09, 95% CI [1.01-1.18]) in multivariate analysis. Multi-fraction SRT dose of 23.31 Gy in 3 fractions has similar efficacy to single-fraction SRT dose of 14 Gy in patients with brain metastases. A slightly higher occurrence of radionecrosis appeared in HFSRT group.
比较单纯采用单次分割放射外科（SRS）或低分割立体定向放疗（HFSRT）治疗脑转移瘤患者的局部控制率和放射性脑坏死发生率。2012 年 1 月至 2017 年 12 月，对 179 例仅 1-3 个脑转移瘤（总数：287 个）患者行单纯 SRS（14Gy）或 HFSRT（23.1Gy，3 次分割，每次 7.7Gy，隔天 1 次）治疗，在单中心进行回顾性分析。152 例患者的 246 个病灶可获得随访影像学数据。SRS 和 HFSRT 组相应的生物有效剂量（BED）分别为 33.6Gy 和 40.9Gy，假设 α/β 为 10Gy。采用 Kaplan-Meier 法计算局部控制率（LC）和放射性脑坏死（RN）风险。SRS 组 6 个月和 12 个月的局部控制率分别为 94%和 88.1%，HFSRT 组分别为 87.6%和 78.4%（p=0.06）。多因素分析仅显示总水肿体积与较差的 LC 相关（p=0.01，HR 1.02，95%CI[1.004-1.03]）。SRS 组发生 1 例放射性脑坏死，HFSRT 组发生 9 例。坏死中位时间为 5.5 个月（范围 1-9 个月）。仅 GTV 体积与 RN 相关（p=0.02，HR 1.09，95%CI[1.01-1.18]）（多因素分析）。3 次分割 23.31Gy 的多分割 SRT 剂量在脑转移瘤患者中与单次分割 14Gy 的 SRT 剂量疗效相当。HFSRT 组放射性脑坏死的发生率略高。
