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立体定向放疗治疗脑转移瘤:放射性坏死的预测因素。

Stereotactic radiotherapy for brain metastases: predictive factors of radionecrosis.

机构信息

Institut Sainte Catherine, 250 Chemin Des Baigne-Pieds, 84000, Avignon, France.

Nouvelles Technologies, PRECIS, Montpellier, France.

出版信息

Eur J Med Res. 2023 Jul 13;28(1):233. doi: 10.1186/s40001-023-01178-4.


DOI:10.1186/s40001-023-01178-4
PMID:37443046
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10339504/
Abstract

PURPOSE: Stereotactic radiotherapy (SRT) is a highly effective approach and represents the current standard of treatment for patients with limited number of brain metastasis (BM). SRT is generally well tolerated but can sometimes lead to radionecrosis (RN). The aim of this study was to identify predictive factors of radionecrosis related to SRT for brain metastasis. METHODS: This retrospective observational cohort study included patients who underwent SRT in the Institut Sainte Catherine between January 1st, 2017 and December 31st, 2020 for the treatment of brain metastasis from any cancer. Individual data and particularly signs of radionecrosis (clinical, imaging, anatomopathological) were collected from electronic medical records. Radionecrosis was defined as the occurrence on MRI of contrast-enhancing necrotic lesions, surrounded by edema, occurring at least 6 months after SRT and localized within fields of irradiation. RESULTS: 123 patients were included; median age was 66 years. 17 patients (11.8%) developed radionecrosis after a median follow up of 418.5 days [63;1498]. Predictive factors of radionecrosis in multivariate analysis were age under 66 years with a sensitivity of 77% and a specificity of 56%. No other factor as the presence of comorbidities, the number of irradiated metastases, the PTV volume or the volume of irradiated healthy brain were predictive of radionecrosis. CONCLUSION: Age at treatment initiation and tumor location seems to be correlated with radionecrosis in patients with brain metastasis treated with SRT. These elements could be useful to adapted radiation therapy.

摘要

目的:立体定向放射治疗(SRT)是一种非常有效的方法,是目前治疗脑转移瘤(BM)数量有限的患者的标准治疗方法。SRT 通常耐受性良好,但有时会导致放射性坏死(RN)。本研究旨在确定与 SRT 治疗脑转移瘤相关的放射性坏死的预测因素。

方法:本回顾性观察队列研究纳入了 2017 年 1 月 1 日至 2020 年 12 月 31 日期间在 Institut Sainte Catherine 接受 SRT 治疗脑转移瘤的患者,这些脑转移瘤来自任何癌症。从电子病历中收集个人数据,特别是放射性坏死的迹象(临床、影像学、解剖病理学)。放射性坏死被定义为 SRT 后至少 6 个月出现 MRI 上的对比增强坏死病变,伴有水肿,且位于照射野内。

结果:共纳入 123 例患者;中位年龄为 66 岁。17 例(11.8%)患者在中位随访 418.5 天后出现放射性坏死[63;1498]。多变量分析中,放射性坏死的预测因素为年龄<66 岁,其敏感性为 77%,特异性为 56%。其他因素,如合并症的存在、放疗转移灶的数量、PTV 体积或放疗的健康脑体积,均与放射性坏死无关。

结论:在接受 SRT 治疗的脑转移瘤患者中,治疗开始时的年龄和肿瘤位置似乎与放射性坏死有关。这些因素对于调整放射治疗可能有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3eb/10339504/626d8dc3a33e/40001_2023_1178_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3eb/10339504/dc05a28df57d/40001_2023_1178_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3eb/10339504/baea406d99b0/40001_2023_1178_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3eb/10339504/626d8dc3a33e/40001_2023_1178_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3eb/10339504/dc05a28df57d/40001_2023_1178_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3eb/10339504/baea406d99b0/40001_2023_1178_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3eb/10339504/626d8dc3a33e/40001_2023_1178_Fig3_HTML.jpg

相似文献

[1]
Stereotactic radiotherapy for brain metastases: predictive factors of radionecrosis.

Eur J Med Res. 2023-7-13

[2]
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[3]
Radionecrosis after stereotactic radiotherapy for brain metastases.

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[4]
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[5]
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Clin Exp Metastasis. 2020-3-17

[6]
Inhomogeneous tumor dose distribution provides better local control than homogeneous distribution in stereotactic radiotherapy for brain metastases.

Radiother Oncol. 2018-7-17

[7]
[Risk of radionecrosis after hypofractionated stereotactic radiotherapy targeting the postoperative resection cavity of brain metastases].

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[8]
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[9]
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[10]
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引用本文的文献

[1]
Prediction of radiologic outcome-optimized dose plans and post-treatment magnetic resonance images: A proof-of-concept study in breast cancer brain metastases treated with stereotactic radiosurgery.

Phys Imaging Radiat Oncol. 2024-6-24

本文引用的文献

[1]
The Evolving Modern Management of Brain Metastasis.

Clin Cancer Res. 2019-6-18

[2]
Brain metastases: epidemiology.

Handb Clin Neurol. 2018

[3]
Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial.

Lancet Oncol. 2017-8

[4]
[Risk of radionecrosis after hypofractionated stereotactic radiotherapy targeting the postoperative resection cavity of brain metastases].

Cancer Radiother. 2017-8

[5]
Stereotactic radiotherapy following surgery for brain metastasis: Predictive factors for local control and radionecrosis.

Cancer Radiother. 2017-2

[6]
Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis.

Int J Radiat Oncol Biol Phys. 2016-7-15

[7]
Radionecrosis after stereotactic radiotherapy for brain metastases.

Expert Rev Neurother. 2016-8

[8]
Volumetric Radiosurgery for 1 to 10 Brain Metastases: A Multicenter, Single-Arm, Phase 2 Study.

Int J Radiat Oncol Biol Phys. 2016-2-1

[9]
Does immunotherapy increase the rate of radiation necrosis after radiosurgical treatment of brain metastases?

J Neurosurg. 2015-11-6

[10]
Comparing Preoperative With Postoperative Stereotactic Radiosurgery for Resectable Brain Metastases: A Multi-institutional Analysis.

Neurosurgery. 2016-8

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