多中心回顾性研究：比较单纯海马回避全脑放疗同期加量与海马回避全脑放疗治疗多发脑转移瘤的倾向性评分匹配分析。

Propensity score-matched analysis comparing hippocampus-avoidance whole-brain radiotherapy plus simultaneous integrated boost with hippocampus‑avoidance whole-brain radiotherapy alone for multiple brain metastases-a retrospective study in multiple institutions.

机构信息

Department of Radiotherapy, The Third Hospital of Zhangzhou, Zhangzhou Fujian, 363005, China.

Department of Radiation Oncology, Army 73rd Group Military Hospital, Xiamen Fujian, 361003, China.

出版信息

BMC Cancer. 2023 Aug 24;23(1):796. doi: 10.1186/s12885-023-11286-3.

DOI:10.1186/s12885-023-11286-3

PMID:37620791

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10464036/

Abstract

BACKGROUND

The optimal treatment for multiple brain metastases has been recently controversially discussed.This study was aimed to explore the feasibility of Hippocampus-Avoidance Whole-Brain Radiotherapy plus a simultaneous integrated boost (HA-WBRT + SIB) in patients with multiple brain metastases and assess tumor control in comparison with Hippocampus-Avoidance Whole-Brain Radiotherapy (HA-WBRT) alone for brain metastases.

METHODS

In this study, 63 patients with multiple brain metastases (≥ 4 metastases) had undergone HA-WBRT + SIB between January 2016 and December 2020 in the observation group:HA-WBRT (30 Gy in 12 fractions, the maximum dose of the hippocampus ≤ 14 Gy) plus a simultaneous integrated boost (48 Gy in 12 fractions) for brain metastases.Overall Survival (OS), Median survival,intracranial control (IC = control within the entire brain), intracranial progression-free survival (iPFS) and adverse events were compared with the control group (a HA-WBRT retrospective cohort) by propensity score matching analysis.

RESULTS

After 1:1 propensity score matching,there were 56 patients in each group (the observation group, the control group). OS, median survival and iPFS were significantly longer in the observation group (18.4 vs. 10.9 months, P<0.001), (13.0 vs. 8.0 months, P<0.001), (13.9 vs.7.8 months, P<0.001). In comparison of 1-year-IC rates, the observation group also demonstrated higher than the control group (51.8% vs. 21.4%, P = 0.002), respectively. Seven hippocampal metastases were found in the control group (4/56,7.1%) and the observation group (3/56,5.4%) after HA-WBRT. The death rate of intracranial progression were 23.2% in the observation group and 37.5% in the control group.All adverse events were not significant difference between the two groups (P>0.05).

CONCLUSIONS

HA-WBRT + SIB resulted in better OS,median survival, IC, iPFS, an acceptable risk of radiation response, and a potential way of declining neurocognitive adverse events, which may be a better treatment for patients with multiple brain metastases.

摘要

背景

对于多发脑转移瘤的最佳治疗方法最近存在争议。本研究旨在探讨在多发脑转移瘤患者中使用海马回避全脑放疗联合同步推量（HA-WBRT+SIB）的可行性，并与单纯海马回避全脑放疗（HA-WBRT）比较评估肿瘤控制情况。

方法

在这项研究中，2016 年 1 月至 2020 年 12 月，63 例多发脑转移瘤（≥4 个转移灶）患者在观察组中接受了 HA-WBRT+SIB：HA-WBRT（12 个分次 30Gy，海马最大剂量≤14Gy）+SIB（12 个分次 48Gy）。采用倾向性评分匹配分析比较两组患者的总生存期（OS）、中位生存时间、颅内控制率（IC=整个脑内控制）、颅内无进展生存期（iPFS）和不良反应。

结果

经 1:1 倾向性评分匹配后，观察组和对照组各有 56 例患者。观察组的 OS、中位生存时间和 iPFS 明显长于对照组（18.4 个月 vs. 10.9 个月，P<0.001）、（13.0 个月 vs. 8.0 个月，P<0.001）、（13.9 个月 vs. 7.8 个月，P<0.001）。比较 1 年 IC 率，观察组也高于对照组（51.8% vs. 21.4%，P=0.002）。HA-WBRT 后，对照组有 7 例（4/56，7.1%）和观察组有 3 例（3/56，5.4%）出现海马转移。观察组颅内进展死亡率为 23.2%，对照组为 37.5%。两组患者的所有不良反应差异均无统计学意义（P>0.05）。