Lin Binwei, Huang Dan, Du Huan, Fan Jinjia, Zhang Yu, Feng Gang, Gao Feng, Du Xiao Bo
Department of Oncology, Mian Yang Central Hospital, Mianyang, China.
Radiology Department, Mian Yang Central Hospital, Mianyang, China.
Front Oncol. 2021 Mar 5;11:631422. doi: 10.3389/fonc.2021.631422. eCollection 2021.
Radiotherapy is one of the most important treatments for brain metastasis (BM). This study aimed to assess whether whole-brain radiation therapy (WBRT) with simultaneous integrated boost (SIB) provided any therapeutic benefit compared to WBRT followed by stereotactic radiosurgery (SRS). Seventy-two consecutive cases of lung cancer with BM treated from January 2014 to June 2020 were analyzed retrospectively. Thirty-seven patients were treated with WBRT (30 Gy in 10 fractions) and SIB (45 Gy in 10 fractions), and 35 patients were treated with WBRT (30 Gy in ten fractions) followed by SRS (16-24 Gy according to the maximum tumor diameter). The primary endpoint was intracranial progression-free survival (PFS). The secondary endpoints were intracranial objective response (partial and complete responses), pattern of intracranial progression, overall survival (OS), and toxicity. The WBRT + SIB group had a significantly longer median intracranial PFS (9.1 vs. 5.9 months, P = 0.001) than the WBRT + SRS group. The intracranial objective response rate was 67.6% and 62.9% in the WBRT + SIB and in WBRT + SRS groups, respectively (P = 0.675). The incidence of progression outside the P-GTV in the WBRT + SIB group was significantly lower than that in the WBRT + SRS group (39.4% vs. 75.0%, P = 0.004). The median OS was 24.3 and 20.3 months in the WBRT + SIB and WBRT + SRS groups, respectively (P = 0.205). There was no significant difference in the incidence of grade 3 or worse adverse reactions between the two groups. Compared to treatment with WBRT + SRS, that with WBRT + SIB for BM appeared to contribute to local control.
放射治疗是脑转移瘤（BM）最重要的治疗方法之一。本研究旨在评估同步整合加量全脑放疗（WBRT+SIB）与全脑放疗后立体定向放射外科（SRS）相比是否具有任何治疗益处。回顾性分析了2014年1月至2020年6月期间连续治疗的72例肺癌脑转移患者。37例患者接受了WBRT（10次分割，30 Gy）和SIB（10次分割，45 Gy）治疗，35例患者接受了WBRT（10次分割，30 Gy）后行SRS（根据最大肿瘤直径给予16 - 24 Gy）治疗。主要终点是颅内无进展生存期（PFS）。次要终点是颅内客观缓解（部分缓解和完全缓解）、颅内进展模式、总生存期（OS）和毒性。WBRT+SIB组的中位颅内PFS显著长于WBRT+SRS组（9.1个月对5.9个月，P = 0.001）。WBRT+SIB组和WBRT+SRS组的颅内客观缓解率分别为67.6%和62.9%（P = 0.675）。WBRT+SIB组在计划靶体积（P-GTV）外进展的发生率显著低于WBRT+SRS组（39.4%对75.0%，P = 0.004）。WBRT+SIB组和WBRT+SRS组的中位OS分别为24.3个月和20.3个月（P = 0.205）。两组3级或更严重不良反应的发生率无显著差异。与WBRT+SRS治疗相比，WBRT+SIB治疗BM似乎有助于局部控制。
