脑转移瘤免疫治疗与立体定向放疗的毒性和时间延迟。
Toxicity and time lapse between immunotherapy and stereotactic radiotherapy of brain metastases.
机构信息
Department of radiation oncology, Jean-Perrin centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France; Department of medical physics, Jean-Perrin centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France; Department of neurosurgery, Gabriel-Montpied university hospital centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
Department of medical oncology, Jean-Perrin centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France; Department of medical physics, Jean-Perrin centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France; Department of neurosurgery, Gabriel-Montpied university hospital centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
出版信息
Cancer Radiother. 2021 Jul;25(5):432-440. doi: 10.1016/j.canrad.2021.01.007. Epub 2021 Apr 6.
PURPOSE
Stereotactic radiotherapy (SRT) is the standard treatment for brain metastases of non-small-cell lung cancer (NSCLC) and melanoma, mostly in combination with immunotherapy. The objective was to retrospectively evaluate the influence of the time-lapse between immunotherapy and stereotactic radiotherapy on toxicity.
PATIENTS AND METHODS
From 2016 to 2019, 59 patients treated with SRT for 103 brain metastases of NSCLC (60%) and melanoma (40%) in combination with concomitant immunotherapy (≤30 days) were included. The prescribed dose was 20Gy/1f or 33Gy/3f at the isocentre and 14Gy or 23.1Gy (70%) respectively at the PTV envelope (PTV=GTV+2mm). The mean tumour diameter was 14mm (4-52mm). The immunotherapies used were anti-PD1 and anti-PDL1. The 103 metastases were classified into 3 groups according to the time-lapse between instatement of immunotherapy and instatement of SRT for the patient concerned: 7 (7%) in group A (≤7 days), 38 (37%) in group B (7 to 14 days) and 58 (56%) in group C (14 to 30 days).
RESULTS
The mean follow-up was 10.1 months. The median overall survival was 11.5 months for NSCLC and 12.5 months for melanoma. The percentage of local control (LC) at one year was 65.1% (93.6% for NSCLC and 26.5% for melanoma). The time-lapse between immunotherapy and SRT was not a significant predictor of LC (P=0.86), while the histology was (P<0.001). The proportion of grade≥3 toxicities was 5.1%, and that of radionecrosis was 9.7% (among these patients, 80% were non-symptomatic): 0%, 13.1% and 8.6% for groups A, B and C respectively. The time-lapse between immunotherapy and SRT was not a significant predictor of toxicity. Only tumour volume was a significant predictive factor (P=0.03).
CONCLUSION
The time lapse between immunotherapy and SRT does not influence brain toxicity. The tumour volume remains the main factor.
目的
立体定向放疗（SRT）是治疗非小细胞肺癌（NSCLC）和黑色素瘤脑转移的标准方法，主要与免疫疗法联合应用。本研究旨在回顾性评估免疫治疗与 SRT 之间的时间间隔对毒性的影响。
方法
纳入 2016 年至 2019 年间，59 例接受 SRT 治疗的 103 例 NSCLC（60%）和黑色素瘤（40%）脑转移患者，这些患者均接受了同期免疫治疗（≤30 天）。处方剂量为 20Gy/1f 或 33Gy/3f 等中心点，14Gy 或 23.1Gy（70%）分别为 PTV 包络（PTV=GTV+2mm）。肿瘤平均直径为 14mm（4-52mm）。免疫治疗药物为抗 PD1 和抗 PDL1。根据患者开始免疫治疗与开始 SRT 之间的时间间隔，将 103 个转移灶分为 3 组：A 组 7 例（≤7 天），B 组 38 例（7-14 天），C 组 58 例（14-30 天）。
结果
中位随访时间为 10.1 个月。NSCLC 患者的中位总生存期为 11.5 个月，黑色素瘤患者的中位总生存期为 12.5 个月。一年局部控制率（LC）为 65.1%（NSCLC 为 93.6%，黑色素瘤为 26.5%）。免疫治疗与 SRT 之间的时间间隔不是 LC 的显著预测因素（P=0.86），而组织学是（P<0.001）。≥3 级毒性的比例为 5.1%，放射性坏死的比例为 9.7%（其中 80%为无症状）：A、B 和 C 组分别为 0%、13.1%和 8.6%。免疫治疗与 SRT 之间的时间间隔不是毒性的显著预测因素。只有肿瘤体积是一个显著的预测因素（P=0.03）。
结论
免疫治疗与 SRT 之间的时间间隔不会影响脑毒性。肿瘤体积仍然是主要因素。
Zotero 插件