Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Neurosurgery, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands.
Department of Radiation Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
Radiother Oncol. 2024 Nov;200:110540. doi: 10.1016/j.radonc.2024.110540. Epub 2024 Sep 16.
Treatment modalities for patients with brain metastases consist of surgery, radiotherapy, and systemic treatments such as immunotherapy and targeted therapy. Although much is known about local control of brain metastases after radiotherapy and surgery alone, more understanding is needed of the additional effect of new systemic treatments. Our study presents real-world data about the combined effects of different local and systemic treatment strategies on local response of irradiated brain metastases.
We performed a retrospective consecutive cohort study of patients that presented with brain metastases in our institution between June 2018 and May 2020, reporting the impact of radiotherapy alone versus radiotherapy combined with systemic treatment on local control of irradiated brain metastases and toxicity. Chemotherapy and targeted therapy were temporarily discontinued around irradiation.
262 consecutively treated patients were included in the study. Median time to local failure of irradiated brain metastases was 18 months (IQR 9-34), median overall survival was 20 months (IQR 10-36). 211 (81 %) patients received systemic treatment. Patients with breast cancer had a worse local control (HR 2.3, 95 % CI 1.0-5.0, p = 0.038), as did patients without any systemic treatment (HR 2.1, 95 % CI 1.1-4.3, p = 0.034). Symptomatic radiation necrosis occurred in 36 (14 %) patients. A diameter > 2.5 cm was associated with a higher risk of radiation necrosis. No association was found between systemic treatment in combination with local radiotherapy and symptomatic radiation necrosis.
Patients who received any form of systemic treatment had better local control after stereotactic radiosurgery for brain metastases. We did not find an association between systemic treatment and the incidence of radiation necrosis.
脑转移瘤患者的治疗方法包括手术、放疗和系统治疗，如免疫治疗和靶向治疗。虽然单独放疗和手术治疗后对脑转移瘤的局部控制有了很多了解，但需要更多地了解新的系统治疗的附加效果。我们的研究提供了关于不同局部和全身治疗策略对放疗后脑转移瘤局部反应的综合影响的真实世界数据。
我们对 2018 年 6 月至 2020 年 5 月在我院就诊的脑转移瘤患者进行了回顾性连续队列研究，报告了单独放疗与放疗联合系统治疗对放疗后脑转移瘤局部控制的影响以及毒性。化疗和靶向治疗在放疗期间暂时停止。
共纳入 262 例连续治疗的患者。放疗后脑转移瘤局部失败的中位时间为 18 个月（IQR 9-34），中位总生存期为 20 个月（IQR 10-36）。211 例（81%）患者接受了系统治疗。乳腺癌患者的局部控制较差（HR 2.3，95%CI 1.0-5.0，p=0.038），未接受任何系统治疗的患者局部控制较差（HR 2.1，95%CI 1.1-4.3，p=0.034）。36 例（14%）患者出现症状性放射性坏死。直径>2.5cm 与放射性坏死风险增加相关。全身治疗联合局部放疗与症状性放射性坏死之间未发现相关性。
接受任何形式的全身治疗的患者在接受立体定向放疗治疗脑转移瘤后局部控制更好。我们没有发现全身治疗与放射性坏死发生率之间的相关性。
