Yamamoto Masaaki, Serizawa Toru, Sato Yasunori, Higuchi Yoshinori, Kawabe Takuya, Kasuya Hidetoshi, Barfod Bierta E
Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan.
Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Adv Radiat Oncol. 2021 May 18;6(6):100721. doi: 10.1016/j.adro.2021.100721. eCollection 2021 Nov-Dec.
The role of stereotactic radiosurgery (SRS) alone for patients with gastrointestinal (GI) cancer has yet to be established based on a large patient series. We analyzed post-SRS treatment results and reappraised whether either the GI graded prognostic assessment (GPA) system or modified-recursive partitioning assessment (M-RPA) system was applicable to our 802 SRS-treated patients with GI cancer with brain metastases.
This was an institutional review board approved retrospective cohort study 2 database comprising 802 patients with GI cancer treated with gamma-knife SRS by 2 experienced neurosurgeons during the 1998 to 2018 period. The Kaplan-Meier method was applied to determine post-SRS survival times, and competing risk analyses were used to estimate cumulative incidences of the secondary endpoints.
The median survival time (MST; months) after SRS was 5.7. With the GI GPA system, MSTs were 3.5/6.1/7.7/11.0 in the 4 subgroups, that is, 0 to 1.0/1.5 to 2.0/2.5 to 3.0/3.5 to 4.0, respectively (stratified < .0001). However, there was no significant MST difference between 2 of the subgroups, GI-GPA 1.5 to 2.0 and 2.5 to 3.0 ( = .073). In contrast, using the M-RPA system, 3 plot lines corresponding to the 3 subgroups showed no overlap and the MST differences between the subgroups with M-RPA were 1 + 2a versus 2b ( < .0001) and 2b versus 2c + 3 ( < .0001). Better Karnofsky performance status score, solitary tumor, well-controlled primary cancer, and the absence of extracerebral metastases were shown by multivariable analysis to be significant predictors of longer survival. The crude and cumulative incidences of neurologic death, neurologic deterioration, local recurrence, salvage whole brain radiation therapy, and SRS-related complications did not differ significantly between the 2 patient groups, with upper and lower GI cancers.
This study clearly demonstrated the usefulness of the GI GPA. Patients with GI GPA 1.5 to 2.0 or better or M-RPA 2b or better are considered to be favorable candidates for treatment with SRS alone.
基于大量患者系列，立体定向放射外科（SRS）单独用于胃肠道（GI）癌患者的作用尚未确立。我们分析了SRS治疗后的结果，并重新评估了GI分级预后评估（GPA）系统或改良递归分区评估（M-RPA）系统是否适用于我们802例接受SRS治疗的GI癌脑转移患者。
这是一项经机构审查委员会批准的回顾性队列研究，2个数据库包含1998年至2018年期间由2名经验丰富的神经外科医生用伽玛刀SRS治疗的802例GI癌患者。采用Kaplan-Meier方法确定SRS后的生存时间，并使用竞争风险分析来估计次要终点的累积发生率。
SRS后的中位生存时间（MST；月）为5.7。采用GI GPA系统时，4个亚组的MST分别为3.5/6.1/7.7/11.0，即分别为0至1.0/1.5至2.0/2.5至3.0/3.5至4.0（分层P <.0001）。然而，GI-GPA 1.5至2.0和2.5至3.0这2个亚组之间的MST无显著差异（P = 0.073）。相比之下，使用M-RPA系统时，对应于3个亚组的3条曲线没有重叠，M-RPA亚组之间的MST差异为1 + 2a与2b（P <.0001）以及2b与2c + 3（P <.0001）。多变量分析显示，较好的卡氏功能状态评分、孤立肿瘤、原发癌控制良好以及无脑外转移是更长生存时间的显著预测因素。神经死亡、神经功能恶化、局部复发、挽救性全脑放疗和SRS相关并发症的粗发病率和累积发病率在上下消化道癌这2组患者之间无显著差异。
本研究清楚地证明了GI GPA的有用性。GI GPA为1.5至2.0或更高或M-RPA为2b或更高的患者被认为是单独接受SRS治疗的合适人选。
