Pan Kaicheng, Wang Bing, Xu Xiao, Liang Jiafeng, Tang Yi, Ma Shenglin, Xia Bing, Zhu Lucheng
Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China.
Department of Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
Discov Oncol. 2024 Jul 30;15(1):318. doi: 10.1007/s12672-024-01191-x.
Lung cancer is a common cause of brain metastases, approximately 40% of patients with lung cancer will develop brain metastases at some point during their disease. Hypofractionated stereotactic radiotherapy (HSRT) has been demonstrated to be effective in controlling limited brain metastases. However, there is still no conclusive on the optimal segmentation of HSRT. The aim of our study was to explore the correlation between the HSRT dosage and its treatment effect and toxicity.
A retrospective analysis was conducted on patients with non-small cell lung cancer (NSCLC) brain metastasis at Hangzhou Cancer Hospital from 1 January 2019 to 1 January 2021. The number of brain metastases did not exceed 10 in all patients and the number of fractions of HSRT was 5. The prescription dose ranges from 25 to 40 Gy. The Kaplan-Meier method was used for estimation of the localised intracranial control rate (iLC). Adverse radiation effects (AREs) were evaluated according to CTCAE 5.0. This study was approved by the Institutional Ethics Review Board of the Hangzhou Cancer Hospital (#73/HZCH-2022).
Forty eligible patients with a total of 70 brain metastases were included in this study. The 1-year iLC was 76% and 89% in the prescribed dose ≤ 30 Gy and > 30 Gy group, respectively (P < 0.05). For patients treated with HSRT combined with targeted therapy, immunotherapy and chemotherapy, the 1-year iLC was 89%, 100%, and 45%, respectively. No significant associations were observed between the number, maximum diameter, location, and type of pathology of brain metastases. The rate of all-grade AREs was 33%. Two patients who received a total dose of 40 Gy developed grade 3 headache, the rest of the AREs were grade 1-2.
Increasing the prescription dose of HSRT improves treatment effect but may also exacerbate the side effects. Systemic therapy might impact the iLC rate, and individualized treatment regimens need to be developed.
肺癌是脑转移的常见原因，约40%的肺癌患者在疾病的某个阶段会发生脑转移。大分割立体定向放射治疗（HSRT）已被证明在控制局限性脑转移方面有效。然而，关于HSRT的最佳分割仍没有定论。我们研究的目的是探讨HSRT剂量与其治疗效果和毒性之间的相关性。
对2019年1月1日至2021年1月1日在杭州肿瘤医院就诊的非小细胞肺癌（NSCLC）脑转移患者进行回顾性分析。所有患者脑转移灶数量不超过10个，HSRT分割次数为5次。处方剂量范围为25至40 Gy。采用Kaplan-Meier法估计局部颅内控制率（iLC）。根据CTCAE 5.0评估放疗不良反应（AREs）。本研究经杭州肿瘤医院机构伦理审查委员会批准（#73/HZCH-2022）。
本研究共纳入40例符合条件的患者，共有70个脑转移灶。处方剂量≤30 Gy组和>30 Gy组的1年iLC分别为76%和89%（P<0.05）。对于接受HSRT联合靶向治疗、免疫治疗和化疗的患者，1年iLC分别为89%、100%和45%。脑转移灶的数量、最大直径、位置和病理类型之间未观察到显著关联。所有级别的AREs发生率为33%。两名接受40 Gy总剂量的患者出现3级头痛，其余AREs为1-2级。
增加HSRT的处方剂量可提高治疗效果，但也可能加重副作用。全身治疗可能会影响iLC率，需要制定个体化的治疗方案。
