Department of Radiotherapy, XuZhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, Jiangsu 221009, China.
Department of Radiotherapy, XuZhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, China.
Biomed Res Int. 2020 Sep 9;2020:6342057. doi: 10.1155/2020/6342057. eCollection 2020.
To analyze retrospectively the clinical efficacy and safety for patients treated with fractionated stereotactic radiation therapy (FSRT) using volumetric modulated arc therapy.
Between 2016 and 2017, 46 patients with solitary brain metastasis who underwent FSRT consisting of 25-40 Gy/5 fractions were recruited in this study. All targets within the same course received different prescriptions according to size. Toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0.
The median follow-up was 11 months (3-53 months). The 6-month and 12-month local control rate calculated by Kaplan-Meier estimate was, respectively, 95% and 86%. Tumor diameter < 2.5 cm obtained 100% improved 12-month local control rate compared with 66% in those with ≥2.5 cm ( < 0.001). The 12-month local control calculated by Kaplan-Meier estimate was 95% in tumors with >30 Gy treatment and only 60% in tumors with ≤30 Gy treatment ( = 0.001). Multivariate analysis revealed that the prescription dose ≤ 30 Gy resulted in increased local failure (hazard ratio (HR), 0.14 (range, 0.019-0.95; = .046)). Grade 3 or worse toxic effects were found in 5 (11%) patients, and no patient experienced surgical resection for symptomatic radioactive necrosis.
FSRT for solid brain metastasis appears to have the advantages of a high rate of local control with a minimal risk of severe toxicity and deserves application in the clinical practice.
回顾性分析容积调强弧形治疗立体定向分割放疗（FSRT）治疗单发脑转移瘤患者的临床疗效和安全性。
2016 年至 2017 年，我们招募了 46 例接受 25-40Gy/5 个分次的 FSRT 的单发脑转移患者。同一疗程内的所有靶区根据大小给予不同的处方。毒性根据不良事件通用术语标准 4.0 分级。
中位随访时间为 11 个月（3-53 个月）。Kaplan-Meier 估计的 6 个月和 12 个月局部控制率分别为 95%和 86%。肿瘤直径<2.5cm 的患者 12 个月局部控制率为 100%，而直径≥2.5cm 的患者为 66%（<0.001）。Kaplan-Meier 估计的 12 个月局部控制率在接受>30Gy 治疗的肿瘤中为 95%，而在接受≤30Gy 治疗的肿瘤中仅为 60%（=0.001）。多变量分析显示，处方剂量≤30Gy 导致局部失败风险增加（风险比（HR），0.14（范围，0.019-0.95；=0.046））。5 例（11%）患者出现 3 级或更高级别的毒性反应，无患者因症状性放射性坏死而行手术切除。
FSRT 治疗实体脑转移瘤具有局部控制率高、严重毒性风险低的优势，值得在临床实践中应用。
