脑转移瘤患者辅助性全脑放疗与立体定向放射治疗后硬脑膜失败率

Rate of pachymeningeal failure following adjuvant WBRT vs SRS in patients with brain metastases.

作者信息

Gutierrez-Valencia Enrique, Kalyvas Aristotelis, Jamora Kurl, Yang Kaiyun, Lau Ruth, Khan Benazir, Millar Barbara-Ann, Laperriere Normand, Conrad Tatiana, Berlin Alejandro, Weiss Jessica, Li Xuan, Zadeh Gelareh, Bernstein Mark, Kongkham Paul, Shultz David B

机构信息

Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.

Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.

出版信息

Clin Transl Radiat Oncol. 2024 Jan 5;45:100723. doi: 10.1016/j.ctro.2023.100723. eCollection 2024 Mar.

DOI:10.1016/j.ctro.2023.100723

PMID:38282910

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10821534/

Abstract

BACKGROUND

Stereotactic radiosurgery (SRS) has supplanted whole brain radiotherapy (WBRT) as standard-of-care adjuvant treatment following surgery for brain metastasis (BrM). Concomitant with the adoption of adjuvant SRS, a new pattern of failure termed "Pachymeningeal failure" (PMF) has emerged.

METHODS

We reviewed a prospective registry of 264 BrM patients; 145 and 119 were treated adjuvantly with WBRT and SRS, respectively. The Cox proportional hazards model was used to identify variables correlating to outcomes. Outcomes were calculated using the cumulative incidence (CI) method. Univariate (UVA) and multivariate analyses (MVA) were done to identify factors associated with PMF.

RESULTS

CI of PMF was 2 % and 18 % at 12 months, and 2 % and 23 % at 24 months for WRBT and SRS, respectively (p < 0.001) The CI of classic leptomeningeal disease (LMD) was 3 % and 4 % at 12 months, and 6 % and 6 % at 24 months for WBRT and SRS, respectively (P = 0.67). On UVA, adjuvant SRS [HR 9.75 (3.43-27.68) (P < 0.001)]; preoperative dural contact (PDC) [HR 6.78 (1.64-28.10) (P = 0.008)]; GPA score [HR 1.64 (1.11-2.42) (P = 0.012)]; and lung EGFR/ALK status [HR 3.11 (1.02-9.45) (P = 0.045)]; were associated with PMF risk. On MVA, adjuvant SRS [HR 8.15 (2.69-24.7) (P < 0.001)]; and PDC [HR 6.28 (1.51-26.1) (P = 0.012)] remained associated with PMF.

CONCLUSIONS

Preoperative dural contact and adjuvant SRS instead of adjuvant WBRT were associated with an increased risk of PMF. Strategies to improve pachymeningeal radiation coverage to sterilize at risk pachymeninges should be investigated.

摘要

背景

立体定向放射外科（SRS）已取代全脑放疗（WBRT），成为脑转移瘤（BrM）手术后标准的辅助治疗方法。随着辅助性SRS的应用，一种新的失败模式——“硬脑膜失败”（PMF）出现了。

方法

我们回顾了一个包含264例BrM患者的前瞻性登记研究；其中145例和119例分别接受了WBRT和SRS辅助治疗。采用Cox比例风险模型来确定与预后相关的变量。使用累积发病率（CI）方法计算预后。进行单因素（UVA）和多因素分析（MVA）以确定与PMF相关的因素。

结果

WBRT和SRS组12个月时PMF的CI分别为2%和18%，24个月时分别为2%和23%（p<0.001）。经典软脑膜疾病（LMD）12个月时WBRT和SRS组的CI分别为3%和4%，24个月时分别为6%和6%（P = 0.67）。单因素分析显示，辅助性SRS [风险比（HR）9.75（3.43 - 27.68）（P<0.001）]；术前硬脑膜接触（PDC）[HR 6.78（1.64 - 28.10）（P = 0.008）]；格拉斯哥预后评分（GPA）[HR 1.64（1.11 - 2.42）（P = 0.012）]；以及肺表皮生长因子受体/间变性淋巴瘤激酶（EGFR/ALK）状态[HR 3.11（1.02 - 9.45）（P = 0.045）]；与PMF风险相关。多因素分析显示，辅助性SRS [HR 8.15（2.69 - 24.7）（P<0.001）]；和PDC [HR 6.28（1.51 - 26.1）（P = 0.012）]仍然与PMF相关。