Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Radiother Oncol. 2022 Dec;177:179-184. doi: 10.1016/j.radonc.2022.10.024. Epub 2022 Oct 28.
Increased oxygen levels may enhance the radiosensitivity of brain metastases treated with stereotactic radiosurgery (SRS). This project administered hyperbaric oxygen (HBO) prior to SRS to assess feasibility, safety, and response.
38 patients were studied, 19 with 25 brain metastases treated with HBO prior to SRS, and 19 historical controls with 27 metastases, matched for histology, GPA, resection status, and lesion size. Outcomes included time from HBO to SRS, quality-of-life (QOL) measures, local control, distant (brain) metastases, radionecrosis, and overall survival.
The average time from HBO chamber to SRS beam-on was 8.3 ± 1.7 minutes. Solicited adverse events (AEs) were comparable between HBO and control patients; no grade III or IV serious AEs were observed. Radionecrosis-free survival (RNFS), radionecrosis-free survival before whole-brain radiation therapy (WBRT) (RNBWFS), local recurrence-free survival before WBRT (LRBWFS), distant recurrence-free survival before WBRT (DRBWFS), and overall survival (OS) were not significantly different for HBO patients and controls on Kaplan-Meier analysis, though at 1-year estimated survival rates trended in favor of SRS + HBO: RNFS - 83% vs 60%; RNBWFS - 78% vs 60%; LRBWFS - 95% vs 78%; DRBWFS - 61% vs 57%; and OS - 73% vs 56%. Multivariate Cox models indicated no significant association between HBO treatment and hazards of RN, local or distant recurrence, or mortality; however, these did show statistically significant associations (p < 0.05) for: local recurrence with higher volume, radionecrosis with tumor resection, overall survival with resection, and overall survival with higher GPA.
Addition of HBO to SRS for brain metastases is feasible without evident decrement in radiation necrosis and other clinical outcomes.
提高氧水平可能会增强立体定向放射外科（SRS）治疗脑转移瘤的放射敏感性。本项目在 SRS 前给予高压氧（HBO）治疗，以评估其可行性、安全性和疗效。
研究了 38 例患者，其中 19 例 25 个脑转移瘤在 SRS 前接受 HBO 治疗，19 例为历史对照，27 个转移瘤匹配组织学、GPA、切除状态和病变大小。结果包括从 HBO 到 SRS 的时间、生活质量（QOL）指标、局部控制、远处（脑）转移、放射性坏死和总生存。
从 HBO 室到 SRS 束开启的平均时间为 8.3±1.7 分钟。HBO 组和对照组患者的不良事件（AE）相似；未观察到 III 级或 IV 级严重 AE。Kaplan-Meier 分析显示，HBO 患者和对照组的放射性坏死无复发生存率（RNFS）、WBRT 前放射性坏死无复发生存率（RNBWFS）、WBRT 前局部无复发生存率（LRBWFS）、WBRT 前远处无复发生存率（DRBWFS）和总生存率（OS）无显著差异，但 1 年估计生存率倾向于 SRS+HBO：RNFS-83% vs 60%；RNBWFS-78% vs 60%；LRBWFS-95% vs 78%；DRBWFS-61% vs 57%；OS-73% vs 56%。多变量 Cox 模型表明，HBO 治疗与放射性坏死、局部或远处复发或死亡率的危险之间没有显著关联；然而，这些模型显示出与以下因素的统计学显著关联（p<0.05）：局部复发与较大体积、放射性坏死与肿瘤切除、总生存与切除、总生存与较高 GPA。
SRS 治疗脑转移瘤时，加用 HBO 是可行的，不会明显增加放射性坏死等临床结局。
