Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Avenue, Columbus, OH, 43210, USA.
Ohio State University School of Medicine, Columbus, OH, USA.
J Neurooncol. 2022 Sep;159(2):389-395. doi: 10.1007/s11060-022-04073-w. Epub 2022 Jun 25.
The current standard of care for patients with a large brain metastasis and limited intracranial disease burden is surgical resection and post-operative single fraction stereotactic radiosurgery (SRS). However, post-operative SRS can still lead to substantial rates of local failure (LF), radiation necrosis (RN), and meningeal disease (MD). Pre-operative SRS may reduce the risk of RN and MD, while fractionated treatments may improve local control by allowing delivery of higher biological effective dose. We hypothesize that pre-operative fractionated stereotactic radiation therapy (FSRT) can minimize rates of LF, RN, and MD.
A retrospective, multi-institutional analysis was conducted and included patients who had pre-operative FSRT for a large or symptomatic brain metastasis. Pertinent demographic, clinical, radiation, surgical, and follow up data were collected for each patient. A primary measurement was the rate of a composite endpoint of (1) LF, (2) MD, and/or (3) Grade 2 or higher (symptomatic) RN.
53 patients with 55 lesions were eligible for analysis. FSRT was prescribed to a dose of 24-25 Gy in 3-5 fractions. There were 0 LFs, 3 Grade 2-3 RN events, and 1 MD occurrence, which corresponded to an 8% per-patient composite endpoint event rate.
In this study, the composite endpoint of 8% for pre-operative FSRT was improved compared to previously reported rates with post-operative SRS of 49-60% (N107C, Mahajan etal. JCOG0504) and pre-operative SRS endpoints of 20.6% (PROPS-BM). Pre-operative FSRT appears to be safe, effective, and may decrease the incidence of adverse outcomes. Prospective validation is needed.
目前，对于颅内疾病负荷有限的大脑转移瘤患者，标准治疗方法是手术切除联合术后单次分割立体定向放射外科治疗（SRS）。然而，术后 SRS 仍可导致局部失败（LF）、放射性坏死（RN）和脑膜疾病（MD）的高发生率。术前 SRS 可能降低 RN 和 MD 的风险，而分割治疗可能通过允许更高的生物有效剂量来提高局部控制率。我们假设术前分割立体定向放疗（FSRT）可以最大限度地降低 LF、RN 和 MD 的发生率。
进行了一项回顾性多机构分析，纳入了接受术前 FSRT 治疗的大或有症状脑转移瘤患者。收集了每位患者的相关人口统计学、临床、放射学、手术和随访数据。主要测量指标是（1）LF、（2）MD 和/或（3）2 级或更高（有症状）RN 的复合终点发生率。
53 例患者的 55 个病灶符合分析条件。FSRT 处方剂量为 24-25Gy，分 3-5 次给予。无 LF 发生，3 例发生 2-3 级 RN，1 例发生 MD，患者复合终点事件发生率为 8%。
在这项研究中，与术后 SRS 的 49-60%（N107C，Mahajan 等人，JCOG0504）和术前 SRS 终点的 20.6%（PROPS-BM）相比，术前 FSRT 的复合终点发生率为 8%，得到了改善。术前 FSRT 似乎是安全有效的，可降低不良事件的发生率。需要前瞻性验证。
