Roquet Nicolas, Beddok Arnaud, Loo Maxime, Calais Gilles, Créhange Gilles, Zemmoura Ilyes, Horodyckid Catherine, Chapet Sophie, Frédéric-Moreau Thomas
Department of Radiation Oncology, Bretonneau Hospital, 2 Bd Tonnellé, Tours, 37000, France.
Department of Radiation Oncology, Godinot Institute, 1 Rue du Général Koenig, Reims, 51100, France.
Clin Exp Metastasis. 2025 Apr 24;42(3):27. doi: 10.1007/s10585-025-10345-2.
This study investigated hypofractionated stereotactic radiotherapy (HSRT) for resected brain metastases and how the dose-fractionation affects local control (LC) and radionecrosis (RN). We retrospectively evaluated patients with brain metastases who were treated between 2010 and 2023. Post-operative HSRT was delivered in three or five fractions. The primary objective was to determine the effect of dose escalation and fractionation on LC. Secondary objectives included identifying factors associated with RN. Statistical analyses were conducted using Chi-square or Fisher's exact tests for categorical data and Mann-Whitney U tests for continuous variables (significance level: p < 0.05). After a median follow-up of 19 months, 34 patients out of 212 (16%) had local recurrence. A biologically effective dose (BED) > 28.8 Gy was associated with better LC (p = 0.002), but no benefit was found for a BED > 48 Gy. RN developed in 34 patients (16%). A prescription BED > 48 Gy was associated with an increased incidence of symptomatic RN (p = 0.002). For HSRT in three fractions, a CTV D99% ≥ 29 Gy significantly improved the LC (p = 0.04), and V30Gy, V23.1 Gy, and V18Gy were significantly associated with an increased risk of RN. The fractionation was not found to affect the LC or RN. This large, retrospective cohort study on post-operative HSRT indicates that a BED of 40.9-48 Gy (3 × 7,7 Gy or 5 × 6 Gy) to the planning target volume results in excellent LC while limiting the risk of RN. No difference in LC or RN was found for different fractionations.
本研究调查了用于切除脑转移瘤的大分割立体定向放射治疗（HSRT）以及剂量分割如何影响局部控制（LC）和放射性坏死（RN）。我们回顾性评估了2010年至2023年间接受治疗的脑转移瘤患者。术后HSRT分三次或五次分割进行。主要目的是确定剂量递增和分割对LC的影响。次要目的包括确定与RN相关的因素。对分类数据使用卡方检验或Fisher精确检验，对连续变量使用Mann-Whitney U检验进行统计分析（显著性水平：p < 0.05）。中位随访19个月后，212例患者中有34例（16%）出现局部复发。生物等效剂量（BED）> 28.8 Gy与更好的LC相关（p = 0.002），但未发现BED > 48 Gy有获益。34例患者（16%）发生了RN。处方BED > 48 Gy与有症状RN的发生率增加相关（p = 0.002）。对于三次分割的HSRT，临床靶体积（CTV）的D99%≥29 Gy显著改善了LC（p = 0.04），V30Gy、V23.1 Gy和V18Gy与RN风险增加显著相关。未发现分割方式影响LC或RN。这项关于术后HSRT的大型回顾性队列研究表明，对计划靶体积给予40.9 - 48 Gy（3×7.7 Gy或5×6 Gy）的BED可在限制RN风险的同时实现出色的LC。不同分割方式在LC或RN方面未发现差异。
