Daisne Jean-François, De Ketelaere Clémentine, Jamart Jacques
Radiation Oncology Department, Université Catholique de Louvain, CHU-UCL-Namur (site Ste-Elisabeth), 5000 Namur, Belgium.
Radiation Oncology Department, Katholieke Universiteit Leuven - University of Leuven, University Hospitals Leuven, 3000 Leuven, Belgium.
Clin Transl Radiat Oncol. 2021 Jan 14;27:70-74. doi: 10.1016/j.ctro.2021.01.003. eCollection 2021 Mar.
Brain metastases are frequently treated with stereotactic radiosurgery (SRS). Radionecrosis (RN) is the late side effect in up to 24% of patients, being symptomatic in 8-10%. Fixed values of the radiosurgical volume receiving 12 Gy or more (V12Gy) are used to roughly predict the global risk. The aim of this retrospective study is to fine-tune the model of individual risk prediction for symptomatic radionecrosis and identify modulating factors.
Data of patients treated with SRS for ≤3 BM of solid tumours at CHU-UCL-Namur were retrospectively reviewed. Doses ranging from 15 to 24 Gy were prescribed to the 70% isodose in function of the lesion diameter. Treatment was administered with a stereotactic linear accelerator. Follow-up magnetic resonance imaging was performed 3-monthly for 18 months and 6-monthly thereafter. RN was prospectively diagnosed and confirmed by the tumour board. V12Gy, previous or salvage whole-brain radiotherapy (WBRT), smoking history, diabetes, postoperative SRS, diagnosis-specific graded prognostic assessment score, cerebral lobe location and relative location (superficial versus deep) were retrieved. Univariate and multivariate analyses were performed to assess their predictive values and derive a model.
128 patients with 220 lesions were analysed. The risk of RN was predicted by a continuous function of the V12Gy (p = 0.005). No other factor had a significant impact, particularly WBRT that did not increase the risk.
The risk of symptomatic RN is predicted on an individual basis by a model in function of the V12Gy and must be confirmed in a prospective study.
脑转移瘤常采用立体定向放射外科治疗（SRS）。放射性坏死（RN）是高达24%患者的晚期副作用，其中8-10%有症状。接受12Gy或更高剂量的放射外科体积固定值（V12Gy）用于大致预测总体风险。这项回顾性研究的目的是对有症状放射性坏死的个体风险预测模型进行微调，并确定调节因素。
回顾性分析在那慕尔大学中心医院（CHU-UCL-Namur）接受SRS治疗≤3个实体瘤脑转移瘤患者的数据。根据病变直径，对70%等剂量线给予15至24Gy的剂量。使用立体定向直线加速器进行治疗。在18个月内每3个月进行一次随访磁共振成像，此后每6个月进行一次。RN由肿瘤委员会进行前瞻性诊断和确认。获取V12Gy、既往或挽救性全脑放疗（WBRT）、吸烟史、糖尿病、术后SRS、诊断特异性分级预后评估评分、脑叶位置和相对位置（浅表与深部）。进行单因素和多因素分析以评估其预测价值并得出模型。
分析了128例患者的220个病变。RN风险通过V12Gy的连续函数预测（p = 0.005）。没有其他因素有显著影响，特别是WBRT并未增加风险。
有症状RN的风险通过基于V12Gy的模型进行个体预测，且必须在前瞻性研究中得到证实。
