Sayan Mutlay, Şahin Bilgehan, Mustafayev Teuta Zoto, Kefelioğlu Erva Şeyma Sare, Vergalasova Irina, Gupta Apar, Balmuk Aykut, Güngör Görkem, Ohri Nisha, Weiner Joseph, Karaarslan Ercan, Özyar Enis, Atalar Banu
Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
Neurocirugia (Engl Ed). 2020 Oct 17. doi: 10.1016/j.neucir.2020.08.009.
Stereotactic radiosurgery (SRS) is a treatment option in the initial management of patients with brain metastases. While its efficacy has been demonstrated in several prior studies, treatment-related complications, particularly symptomatic radiation necrosis (RN), remains as an obstacle for wider implementation of this treatment modality. We thus examined risk factors associated with the development of symptomatic RN in patients treated with SRS for brain metastases.
We performed a retrospective review of our institutional database to identify patients with brain metastases treated with SRS. Diagnosis of symptomatic RN was determined by appearance on serial MRIs, MR spectroscopy, requirement of therapy, and the development of new neurological complaints without evidence of disease progression.
We identified 323 brain metastases treated with SRS in 170 patients from 2009 to 2018. Thirteen patients (4%) experienced symptomatic RN after treatment of 23 (7%) lesions. After SRS, the median time to symptomatic RN was 8.3 months. Patients with symptomatic RN had a larger mean target volume (p<0.0001), and thus larger V100% (p<0.0001), V50% (p<0.0001), V12Gy (p<0.0001), and V10Gy (p=0.0002), compared to the rest of the cohort. Single-fraction treatment (p=0.0025) and diabetes (p=0.019) were also significantly associated with symptomatic RN.
SRS is an effective treatment option for patients with brain metastases; however, a subset of patients may develop symptomatic RN. We found that patients with larger tumor size, larger plan V100%, V50%, V12Gy, or V10Gy, who received single-fraction SRS, or who had diabetes were all at higher risk of symptomatic RN.
立体定向放射外科（SRS）是脑转移瘤患者初始治疗的一种选择。虽然其疗效已在多项先前研究中得到证实，但治疗相关并发症，尤其是症状性放射性坏死（RN），仍然是这种治疗方式更广泛应用的障碍。因此，我们研究了接受SRS治疗脑转移瘤患者发生症状性RN的相关危险因素。
我们对机构数据库进行了回顾性分析，以确定接受SRS治疗的脑转移瘤患者。症状性RN的诊断通过系列MRI表现、磁共振波谱分析、治疗需求以及出现无疾病进展证据的新神经症状来确定。
我们确定了2009年至2018年期间170例患者中接受SRS治疗的323个脑转移瘤。13例患者（4%）在23个（7%）病灶治疗后出现症状性RN。SRS治疗后，出现症状性RN的中位时间为8.3个月。与队列中的其他患者相比，出现症状性RN的患者平均靶体积更大（p<0.0001），因此V100%（p<0.0001）、V50%（p<0.0001）、V12Gy（p<0.0001）和V10Gy（p=0.0002）也更大。单次分割治疗（p=0.0025）和糖尿病（p=0.019）也与症状性RN显著相关。
SRS是脑转移瘤患者的一种有效治疗选择；然而，一部分患者可能会发生症状性RN。我们发现肿瘤体积较大、计划V100%、V50%、V12Gy或V10Gy较大、接受单次分割SRS治疗或患有糖尿病的患者发生症状性RN的风险均较高。
