Daşgın Feyza Yaşar, Kargıoğlu Tarı, Arslan Aliye, Aksakal Ali Kerim, Dadak Binnur, Ayrak Fatma Betül, Gökçe Ezgi, Aral İpek Pinar, Altınışık İnan Gonca, Tezcan Yılmaz
Department of Radiation Oncology, Ankara Bilkent City Hospital Ankara, Turkey.
Department of Radiation Oncology, Ankara Bilkent City Hospital Ankara, Turkey; Department of Radiation Oncology, Ankara Yıldırım Beyazıt University Ankara, Turkey.
Thorac Res Pract. 2023 Sep;24(5):270-275. doi: 10.5152/ThoracResPract.2023.23025.
This study reports the results of stereotactic radiosurgery and fractionated stereotactic radiosurgery treatment for brain metastasis in non-small cell lung cancer patients treated with modern systemic treatment methods (immunotherapy, targeted agents, and current chemotherapy agents).
This study retrospectively analyzed patients diagnosed with non-small cell lung cancer and brain metasta- ses who underwent stereotactic radiosurgery/fractionated stereotactic radiosurgery in the Radiation Oncology Clinic of Ankara Bilkent City Hospital between February 21, 2019, and August 15, 2022. The study's primary endpoint was accepted as the lesions' response sta- tus after stereotactic radiosurgery/fractionated stereotactic radiosurgery.The secondary endpoint was accepted as the patients' intracranial progression-free survival and overall survival.
This study included 85 patients treated for 174 lesions. Their median follow-up was 6.6 (range: 1-42) months.Their median intracranial progression-free survival after radiotherapy was 5.3 (range: 1-33) months, and their median overall survival was 6.6 (range: 1-42) months. Concurrent immunotherapy was administered to 10 (11%) patients and targeted therapy to 8 (9%). Magnetic resonance imaging indicated that 14 (6%) patients had a complete response, 62 (35.6%) had a partial response, 10 (5.7%) had stable disease, and 23 (13.2%) had progressive disease. The complete response rate was significantly higher in patients receiving targeted therapy (P < .001; odds ratio = 0.0025, 95% CI = 0.006-0.109). Intracranial recurrence was observed in 28 (32.9%) patients after stereotactic radiosurgery/ fractionated stereotactic radiosurgery: 7 (8.2%) were inside the radiotherapy field, 13 (15.3%) were outside the radiotherapy field, and 8 (9.4%) overlapped the radiotherapy field. Intracranial progression-free survival was higher in patients receiving concomitant immu- notherapy (P = .028; hazard ratio = 0.107, 95% CI = 0.015-0.783). However, overall survival was higher in patients receiving targeted therapy (P = .035; hazard ratio = 0.217, 95% CI = 0.053-0.897).
Using current systemic agents with radiotherapy for brain metastasis significantly affected post-radiotherapy intracranial progression-free survival.
本研究报告了采用现代全身治疗方法（免疫疗法、靶向药物和当前化疗药物）治疗的非小细胞肺癌患者脑转移的立体定向放射外科和分次立体定向放射外科治疗结果。
本研究回顾性分析了2019年2月21日至2022年8月15日期间在安卡拉比尔肯特市医院放射肿瘤诊所接受立体定向放射外科/分次立体定向放射外科治疗的非小细胞肺癌和脑转移患者。该研究的主要终点被视为立体定向放射外科/分次立体定向放射外科治疗后病灶的反应状态。次要终点被视为患者的颅内无进展生存期和总生存期。
本研究纳入了85例接受174个病灶治疗的患者。他们的中位随访时间为6.6（范围：1 - 42）个月。放疗后他们的中位颅内无进展生存期为5.3（范围：1 - 33）个月，中位总生存期为6.6（范围：1 - 42）个月。10例（11%）患者接受了同步免疫治疗，8例（9%）患者接受了靶向治疗。磁共振成像显示，14例（6%）患者完全缓解，62例（35.6%）部分缓解，10例（5.7%）病情稳定，23例（13.2%）病情进展。接受靶向治疗的患者完全缓解率显著更高（P <.001；比值比 = 0.0025，95%置信区间 = 0.006 - 0.109）。立体定向放射外科/分次立体定向放射外科治疗后，28例（32.9%）患者出现颅内复发：7例（8.2%）在放疗野内，13例（15.3%）在放疗野外，8例（9.4%）与放疗野重叠。接受同步免疫治疗的患者颅内无进展生存期更高（P =.028；风险比 = 0.107，95%置信区间 = 0.015 - 0.783）。然而，接受靶向治疗的患者总生存期更高（P =.035；风险比 = 0.217，95%置信区间 = 0.053 - 0.897）。
使用当前全身药物联合放疗治疗脑转移显著影响放疗后的颅内无进展生存期。
