Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA.
BMC Cancer. 2021 May 15;21(1):552. doi: 10.1186/s12885-021-08302-9.
Little is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM).
Twenty-three patients with BCBM underwent 31 stereotactic sessions to 90 lesions from 2005 to 2019 with receipt of capecitabine. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of stereotactic radiation. Imaging was independently reviewed by a neuro-radiologist.
Median follow-up from stereotactic radiation was 9.2 months. Receptor types of patients treated included triple negative (n = 7), hormone receptor (HR)+/HER2- (n = 7), HR+/HER2+ (n = 6), and HR-/HER2+ (n = 3). Fourteen patients had stage IV disease prior to BCBM diagnosis. The median number of brain metastases treated per patient was 3 (1 to 12). The median dose of stereotactic radiosurgery (SRS) was 21 Gy (range: 15-24 Gy) treated in a single fraction and for lesions treated with fractionated stereotactic radiation therapy (FSRT) 25 Gy (24-30 Gy) in a median of 5 fractions (range: 3-5). Of the 31 stereotactic sessions, 71% occurred within 1 month of capecitabine. No increased toxicity was noted in our series with no cases of radionecrosis. The 1-year OS, LC, and DIC were 46, 88, and 30%, respectively.
In our single institution experience, we demonstrate stereotactic radiation and capecitabine to be a safe treatment for patients with BCBM with adequate LC. Further study is needed to determine the potential synergy between stereotactic radiation and capecitabine in the management of BCBM.
关于乳腺癌脑转移（BCBM）患者同时接受卡培他滨和立体定向放疗的安全性和疗效知之甚少。
2005 年至 2019 年期间，23 例 BCBM 患者共进行了 31 次立体定向治疗，90 个病灶，同时接受卡培他滨治疗。采用 Kaplan-Meier 法计算从立体定向放疗开始的总生存期（OS）、局部控制率（LC）和远处颅内控制率（DIC）。影像学由神经放射科医生独立评估。
从立体定向放疗开始的中位随访时间为 9.2 个月。治疗患者的受体类型包括三阴性（n=7）、激素受体（HR）+/HER2-（n=7）、HR+/HER2+（n=6）和 HR-/HER2+（n=3）。14 例患者在诊断为 BCBM 之前患有 IV 期疾病。每位患者治疗的脑转移瘤中位数为 3 个（1-12 个）。立体定向放射外科（SRS）的中位剂量为 21 Gy（范围：15-24 Gy），单次分割；对于接受分割立体定向放射治疗（FSRT）的病变，中位剂量为 25 Gy（24-30 Gy），5 次分割（范围：3-5 次）。31 次立体定向治疗中，71%在卡培他滨治疗后 1 个月内进行。我们的系列研究中未发现放射性坏死增加的毒性。1 年 OS、LC 和 DIC 分别为 46%、88%和 30%。
在我们的单机构经验中，我们证明了立体定向放疗和卡培他滨治疗 BCBM 患者是安全的，LC 令人满意。需要进一步研究来确定立体定向放疗和卡培他滨在 BCBM 治疗中的潜在协同作用。
