Hoelzl Florian, Koelbl Oliver, Gruber Isabella
University of Regensburg, Regensburg, Germany.
Department of Radiation Oncology, University Hospital of Regensburg, Regensburg, Germany.
Cancer Med. 2024 Dec;13(24):e70522. doi: 10.1002/cam4.70522.
The role of whole-brain radiotherapy for patients with brain metastases is changing as immunotherapy and molecularly targeted therapies advance. However, whole-brain radiotherapy continues to be part of the multimodal concept.
This retrospective study included 285 patients who received whole-brain radiotherapy for brain metastases, using a median dose of 30 Gy. The study analyzed prognostic factors for survival using Cox regression analyses, while two landmark analyses, reflecting a minimum survival of 60 and 90 days, accounted for early deaths. Neurological symptoms were compared before and after treatment using the McNemar test.
The median patient age was 62 years. Non-small cell lung cancer (n = 95), breast cancer (n = 53), and small cell lung cancer (n = 48) were the most frequent cancer types. Median survival was 4.3 months (interquartile range 1.8-11.1). In the multivariable Cox regression model, patients who received additional immunotherapy/molecularly targeted therapy had a higher chance of survival than others. Overall survival was influenced by control of primary cancer, extracranial metastases, age, Karnofsky performance status, and number of brain metastases. The 90-day landmark analysis included 181 patients who survived at least 90 days, reflecting that 104 patients (36.5%) died within the first 90 days. The 90-day landmark analysis confirmed all predictive variables for survival. Patients who died before the 90-day landmark endpoint had more brain metastases, lower Karnofsky performance status, higher age, and were less frequently treated with immunotherapy/molecularly targeted therapy than those surviving at least 90 days. The treatment significantly improved neurological symptoms.
These results indicate an insufficient patient selection, as one-third of patients treated with whole-brain radiotherapy died within 90 days. However, neurological symptoms improved, and the addition of immunotherapy and/or molecularly targeted therapy to whole-brain radiotherapy was associated with better survival. Patients receiving whole-brain irradiation should be more carefully selected.
ClinicalTrials: 24-3626-104.
随着免疫疗法和分子靶向疗法的发展，全脑放疗在脑转移瘤患者中的作用正在发生变化。然而，全脑放疗仍是多模式治疗理念的一部分。
这项回顾性研究纳入了285例接受全脑放疗治疗脑转移瘤的患者，中位剂量为30 Gy。该研究使用Cox回归分析来分析生存的预后因素，同时进行两项标志性分析，反映至少60天和90天的最低生存期，以考虑早期死亡情况。使用McNemar检验比较治疗前后的神经症状。
患者的中位年龄为62岁。非小细胞肺癌（n = 95）、乳腺癌（n = 53）和小细胞肺癌（n = 48）是最常见的癌症类型。中位生存期为4.3个月（四分位间距1.8 - 11.1）。在多变量Cox回归模型中，接受额外免疫疗法/分子靶向疗法的患者比其他患者有更高的生存机会。总生存期受原发癌控制情况、颅外转移、年龄、卡氏功能状态和脑转移瘤数量的影响。90天标志性分析纳入了181例至少存活90天的患者，这表明104例患者（36.5%）在最初90天内死亡。90天标志性分析证实了所有生存预测变量。在90天标志性终点之前死亡的患者比至少存活90天的患者有更多的脑转移瘤、更低的卡氏功能状态、更高的年龄，并且接受免疫疗法/分子靶向疗法的频率更低。该治疗显著改善了神经症状。
这些结果表明患者选择不足，因为接受全脑放疗的患者中有三分之一在90天内死亡。然而，神经症状得到改善，并且在全脑放疗中添加免疫疗法和/或分子靶向疗法与更好的生存相关。接受全脑照射的患者应更谨慎地选择。
ClinicalTrials: 24 - 3626 - 104。
