肉瘤原发性脑转移瘤立体定向放射治疗后的临床结果：一项国际多中心分析。

Clinical outcomes following stereotactic radiosurgery for brain metastases from sarcoma primaries: An international multicenter analysis.

作者信息

Singh Raj, Roubil John G, Bowden Greg, Mathieu David, Carrier Louis, Shepard Matthew, Kite Trent, Wegner Rodney E, Picozzi Piero, Franzini Andrea, Yang Huai-Che, Lee Cheng-Chia, Wei Zhishuo, Hoang Andrew, Hess Judith, Fathima Bushra, Chiang Veronica, Peker Selcuk, Samanci Yavuz, Liscak Roman, Simonova Gabriela, Paro Mitch, Kamen Scott, McInerney James, Zacharia Brad E, Sumi Takuma, Kano Hideyuki, Bueno Angel, Dono Antonio, Blanco Angel I, Esquenazi Yoshua, Alzate Juan Diego, Briggs Robert G, Yu Cheng, Zada Gabriel, Cifarelli Christopher P, Cifarelli Daniel T, Almeida Timoteo, Benjamin Carolina, Costa Ronan, Speckter Herwin, Gonzalez Ivan, Marinho Andrade de Moura Anais Concepcion, Kondziolka Douglas, Bernstein Kenneth, Shaaban Ahmed, Lunsford L Dade, Niranjan Ajay, Konieczkowski David J, Palmer Joshua D, Sheehan Jason P

机构信息

Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Department of Radiation Oncology, Massey Comprehensive Cancer Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA.

出版信息

Cancer. 2025 Jul 1;131(13):e35931. doi: 10.1002/cncr.35931.

DOI:10.1002/cncr.35931

PMID:40543045

Abstract

BACKGROUND

There is a paucity of data on treatment outcomes following stereotactic radiosurgery (SRS) for brain metastases from sarcoma primaries.

METHODS

The International Radiosurgery Research Foundation member-sites were queried for patients with brain metastases from sarcoma primaries treated with SRS. Overall survival (OS) and local control (LC) were calculated via Kaplan-Meier analysis. Univariate analyses examined prognostic factors associated with LC and OS via log-rank t-tests and multivariate analyses (MVA) via Cox proportional hazards model.

RESULTS

A total of 146 patients with 309 brain metastases were identified. Two-hundred and thirty lesions were treated with single-fraction SRS with a median dose of 20 Gy (15-24 Gy). Ninety-five patients had extracranial metastases, including 75 oligometastatic patients. One- and 2-year OS and LC rates were 47.7% and 37.3%, and 78.3% and 62.2%, respectively. On univariate analyses, superior 1-year OS was noted among leiomyosarcomas (69.7% vs. 42.6%; p = .02) with poorer outcomes among pleomorphic histologies (10.5% vs. 50.7%; p = .002). Pleomorphic histologies were associated with poorer OS on MVA (hazard ratio [HR], 3.13; p = .006). On MVA, LC was inferior among patients of age ≥45 years (HR, 3.78; p < .001) and superior among leiomyosarcomas (HR, 0.31; p = .03). OS was prognosticated based on adverse factors (ie, nonleiomyosarcoma histology and progressive extracranial metastases). Two-year OS for patients with and without adverse features were 78.6% and 31.5%, respectively.

CONCLUSIONS

LC outcomes were driven by histology and age with superior LC among leiomyosarcomas and patients of age <45 years. OS was driven by nonleiomyosarcoma histology and the presence of progressive extracranial disease.

摘要

背景

关于肉瘤原发灶脑转移瘤立体定向放射外科治疗（SRS）后的治疗结果，数据较少。

方法

查询国际放射外科研究基金会成员站点中接受SRS治疗的肉瘤原发灶脑转移瘤患者。通过Kaplan-Meier分析计算总生存期（OS）和局部控制率（LC）。单因素分析通过对数秩检验检查与LC和OS相关的预后因素，多因素分析（MVA）通过Cox比例风险模型进行。

结果

共确定了146例患者的309个脑转移瘤。230个病灶接受了单次分割SRS治疗，中位剂量为20 Gy（15 - 24 Gy）。95例患者有颅外转移，其中75例为寡转移患者。1年和2年的OS率和LC率分别为47.7%和37.3%，以及78.3%和62.2%。单因素分析显示，平滑肌肉瘤患者1年OS较好（69.7%对42.6%；p = 0.02），多形性组织学患者预后较差（10.5%对50.7%；p = 0.002）。多因素分析显示多形性组织学与较差的OS相关（风险比[HR]，3.13；p = 0.006）。多因素分析中，年龄≥45岁的患者LC较差（HR，3.78；p < 0.001），平滑肌肉瘤患者LC较好（HR，0.31；p = 0.03）。根据不良因素（即非平滑肌肉瘤组织学和进行性颅外转移）对OS进行预测。有和无不良特征的患者2年OS分别为78.6%和31.5%。