Department of Radiation Therapy, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, 67200, Strasbourg, France.
Medical Physics Unit, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, 67200, Strasbourg, France.
Radiat Oncol. 2023 Jan 30;18(1):21. doi: 10.1186/s13014-023-02200-z.
Brain metastases (BMs) are the leading cause of intracranial malignant neoplasms in adults. WHO, Karnofsky performance status (KPS), age, number of BMs, extracerebral progression (ECP), recursive partitioning analysis (RPA), diagnosis-specific graded prognostic assessment (Ds-GPA) are validated prognostic tools to help clinicians decide on treatment. No consensus exists for repeat stereotactic radiotherapy (SRT) for BMs. The aim of this study was to review the changes in patient characteristics treated with repeated SRTs.
The data of patients treated between 2010 and 2020 with at least two courses of SRT without previous whole brain radiotherapy (WBRT) were reviewed. Age, WHO, KPS, ECP, type of systemic treatment, number of BMs were recorded. RPA, Ds-GPA and brain metastasis velocity (BMV) were calculated.
184 patients were treated for 915 BMs and received two to six SRTs for local or distant brain recurrence. The median number of BMs treated per SRT was 1 (range: 1-6), for a median of 4 BMs treated during all sessions (range: 2-19). WHO, Ds-GPA and RPA were stable between each session of SRT, whereas KPS was significantly better in SRT1 than in the following SRT. The number of BMs was not significantly different between each SRT, but there was a tendency for more BM at SRT1 (p = 0.06). At SRT1, patients had largest BM and undergo more surgery than during the following SRT (p < 0.001). 6.5%, 37.5% and 56% of patients were classified as high, intermediate, and low BMV, respectively, at the last SRT session. There was almost perfect concordance between the BMV-grade calculated at the last SRT session and at SRT2 (r = 0.89; p < 0.001).
Repeated SRT doesn't lead to a marked alteration in the general condition, KPS was maintained at over 70% for more than 95% of patients during all SRTs. Long survival can be expected, especially in low-grade BMV patients. WBRT shouldn't be aborted, especially for patients developing more than twelve BMs annually.
脑转移瘤（BMs）是成人颅内恶性肿瘤的主要原因。世界卫生组织（WHO）、卡氏功能状态评分（KPS）、年龄、BM 数量、颅外进展（ECP）、递归分区分析（RPA）、诊断特异性分级预后评估（Ds-GPA）是经证实的用于帮助临床医生制定治疗方案的预后工具。对于复发性立体定向放疗（SRT）治疗 BMs，目前尚未达成共识。本研究旨在回顾接受多次 SRT 治疗的患者特征变化。
回顾了 2010 年至 2020 年间至少接受两次 SRT 治疗且未接受过全脑放疗（WBRT）的患者数据。记录年龄、WHO、KPS、ECP、全身治疗类型、BM 数量。计算 RPA、Ds-GPA 和脑转移瘤生长速度（BMV）。
184 例患者共接受 915 次 SRT 治疗，以治疗局部或远处脑复发。每次 SRT 治疗的 BM 中位数为 1（范围：1-6），所有治疗中治疗的 BM 中位数为 4（范围：2-19）。在每次 SRT 之间，WHO、Ds-GPA 和 RPA 均保持稳定，而 KPS 在 SRT1 时明显优于后续 SRT。每次 SRT 之间的 BM 数量无明显差异，但 SRT1 时 BM 数量有增加的趋势（p=0.06）。在 SRT1 时，患者的 BM 最大，且接受手术治疗的比例高于后续 SRT（p<0.001）。最后一次 SRT 时，分别有 6.5%、37.5%和 56%的患者被归类为高、中、低 BMV 级。最后一次 SRT 时计算的 BMV 级与 SRT2 时几乎完全一致（r=0.89；p<0.001）。
重复 SRT 不会导致一般状况的明显改变，超过 95%的患者在所有 SRT 中 KPS 保持在 70%以上。预计会有较长的生存期，尤其是在低 BMV 级别的患者中。WBRT 不应终止，特别是对于每年新发超过 12 个 BM 的患者。
