Nieder Carsten, Aanes Siv Gyda, Stanisavljevic Luka, Mannsåker Bård
Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway.
Department of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
Discov Oncol. 2024 Sep 27;15(1):495. doi: 10.1007/s12672-024-01358-6.
This retrospective study analyzed the incidence of subsequent brain metastases after palliative radiotherapy or chemoradiation in patients with stage II/III non-small cell lung cancer (NSCLC). Risk factors for brain metastases development and survival after diagnosis were evaluated.
Different baseline parameters including but not limited to age, stage and target volume size were assessed. Outcomes were abstracted from electronic health records. Uni- and multivariate tests were performed.
The study included 102 patients and found an actuarial risk of brain metastases of 15% (standard error ± 4) at one year and 20% (± 5) at two years. The maximum time interval was 15 months from start of radiation treatment. A non-significant survival difference was observed (median 12 months without versus 8.3 months with brain metastases, p = 0.21). Incidence was higher in patients with N2/3 stage, larger planning target volume size, and younger age (univariately significant factors). Trends were seen for stage III and adenocarcinoma histology. The multivariate analysis confirmed age as the most important risk factor.
The risk of brain metastases development was comparable to that reported in studies of curative chemoradiation. All events occurred within 15 months of follow-up, suggesting that long-term surveillance imaging may not be warranted. Patients younger than 60 years had a very high risk of brain metastases development.
本回顾性研究分析了II/III期非小细胞肺癌（NSCLC）患者接受姑息性放疗或放化疗后发生脑转移的发生率。评估了脑转移发生的危险因素及诊断后的生存率。
评估了不同的基线参数，包括但不限于年龄、分期和靶区体积大小。从电子健康记录中提取结果。进行了单因素和多因素检验。
该研究纳入了102例患者，发现1年时脑转移的精算风险为15%（标准误差±4），2年时为20%（±5）。从放疗开始起的最长时间间隔为15个月。观察到生存率无显著差异（无脑转移患者的中位生存期为12个月，有脑转移患者为8.3个月，p = 0.21）。N2/3期、计划靶区体积较大和年龄较轻的患者发生率较高（单因素显著因素）。III期和腺癌组织学有相关趋势。多因素分析证实年龄是最重要的危险因素。
脑转移发生的风险与根治性放化疗研究中报告的风险相当。所有事件均发生在随访的15个月内，这表明可能无需进行长期监测成像。年龄小于60岁的患者发生脑转移的风险非常高。
