黑色素瘤脑转移对立体定向放射外科治疗反应中瘤周水肿体积的预测价值。
Predictive value of perilesional edema volume in melanoma brain metastasis response to stereotactic radiosurgery.
作者信息
Yavorska Mariya, Tomaciello Miriam, Sciurti Antonio, Cinelli Elisa, Rubino Giovanni, Perrella Armando, Cerase Alfonso, Pastina Pierpaolo, Gravina Giovanni Luca, Arcieri Silvia, Mazzei Maria Antonietta, Migliara Giuseppe, Baccolini Valentina, Marampon Francesco, Minniti Giuseppe, Di Giacomo Anna Maria, Tini Paolo
机构信息
Unit of Radiation Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
Radiation Oncology, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
出版信息
J Neurooncol. 2024 Dec;170(3):611-618. doi: 10.1007/s11060-024-04818-9. Epub 2024 Sep 11.
BACKGROUND AND AIM
Stereotactic radiotherapy (SRT) is an established treatment for melanoma brain metastases (MBM). Recent evidence suggests that perilesional edema volume (PEV) might compromise the delivery and efficacy of radiotherapy to treat BM. This study investigated the association between SRT efficacy and PEV extent in MBM.
MATERIALS AND METHODS
This retrospective study reviewed medical records from January 2020 to September 2023. Patients with up to 5 measurable MBMs, intracranial disease per RANO/iRANO criteria, and on low-dose corticosteroids were included. MRI scans assessed baseline neuroimaging, with PEV analyzed using 3D Slicer. SRT plans were based on MRI-CT fusion, delivering 18-32.5 Gy in 1-5 fractions. Outcomes included intracranial objective response rate (iORR) and survival measures (L-iPFS and OS). Statistical analysis involved decision tree analysis and multivariable logistic regression, adjusting for clinical and treatment variables.
RESULTS
Seventy-two patients with 101 MBM were analyzed, with a mean age of 68.83 years. The iORR was 61.4%, with Complete Response (CR) in 21.8% and Partial Response (PR) in 39.6% of the treated lesions. PEV correlated with KPS, BRAF status, and treatment response. Decision tree analysis identified a PEV cutoff at 0.5 cc, with lower PEVs predicting better responses (AUC = 0.82 sensitivity: 86.7%, specificity:74.4%,). Patients with PEV ≥ 0.5 cc had lower response rates (iORR 44.7% vs. 63.8%, p < 0.001). Median OS was 9.4 months, with L-iPFS of 27 months. PEV significantly impacted survival outcomes.
CONCLUSIONS
A more extensive PEV was associated with a less favorable outcome to SRT in MBM.
背景与目的
立体定向放射治疗（SRT）是治疗黑色素瘤脑转移（MBM）的一种既定疗法。最近的证据表明，瘤周水肿体积（PEV）可能会影响放射治疗治疗脑转移瘤的剂量输送和疗效。本研究调查了MBM中SRT疗效与PEV范围之间的关联。
材料与方法
这项回顾性研究回顾了2020年1月至2023年9月的病历。纳入了最多有5个可测量MBM、符合RANO/iRANO标准的颅内疾病且正在接受低剂量皮质类固醇治疗的患者。MRI扫描评估基线神经影像学，使用3D Slicer分析PEV。SRT计划基于MRI-CT融合，分1-5次给予18-32.5 Gy。结果包括颅内客观缓解率（iORR）和生存指标（L-iPFS和OS）。统计分析包括决策树分析和多变量逻辑回归，并对临床和治疗变量进行了调整。
结果
分析了72例患有101个MBM的患者，平均年龄为68.83岁。iORR为61.4%，治疗的病灶中完全缓解（CR）占21.8%，部分缓解（PR）占39.6%。PEV与KPS、BRAF状态和治疗反应相关。决策树分析确定PEV临界值为0.5 cc，较低的PEV预示着更好的反应（AUC = 0.82，敏感性：86.7%，特异性：74.4%）。PEV≥0.5 cc的患者缓解率较低（iORR 44.7%对63.8%，p < 0.001）。中位OS为9.4个月，L-iPFS为27个月。PEV对生存结果有显著影响。
结论
在MBM中，更广泛的PEV与SRT的较差结果相关。
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