一项回顾性倾向匹配研究，比较全脑放疗联合同步整合加量与单纯全脑放疗用于脑转移瘤的疗效。

A retrospective propensity-matched study comparing whole-brain radiotherapy with simultaneous integrated boost to whole-brain radiotherapy alone for brain metastases.

作者信息

Liu Zheqing, Du Xiaojing, Deng Meiling, Chen Yuanyuan, Wu Shaoxiong

机构信息

Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P.R. China.

出版信息

BMC Cancer. 2025 Jul 1;25(1):1121. doi: 10.1186/s12885-025-14443-y.

DOI:10.1186/s12885-025-14443-y

PMID:40596961

Abstract

BACKGROUND

The effectiveness of whole brain radiation therapy with simultaneous integrated boost (WBRT-SIB) in comparison to whole brain radiation therapy alone (WBRT-alone) is yet unknown, despite the fact that its use in clinic is growing. To investigate the variations in intracranial control and overall survival (OS) between the two approaches, we conducted a matching comparison for patients with brain metastases (BM).

METHOD

From January 1, 2015, to December 31, 2019, a total of 245 BM patients were eligible for inclusion, including 154 patients who received WBRT-alone (30 Gy/10 fractions) and 91 patients who received WBRT-SIB (40-50 Gy/10 fractions). 1:1 propensity score matching was used to select the patients with balanced baseline characteristics. The intracranial control and OS condition were analyzed using Kaplan-Meier method, Log-rank test, and Cox proportional hazard regression model.

RESULTS

138 patients were matched into the WBRT-SIB group and the WBRT-alone group. Of these, 113 (81.9%) patients had BM originating from the lungs, and 124 (89.9%) patients had more than 3 intracranial lesions. After the initiation of radiotherapy, the WBRT-SIB group and the WBRT-alone group had respective 2-year intracranial progression-free survival (iPFS), local progression-free survival (iLPFS), and distant progression-free survival (iDPFS) of 46.2% and 24.5% (p = 0.017), 49.4% and 29.8% (p = 0.033), and 68.6% and 54.4% (p = 0.040). There was no significant difference in OS (22.2 vs. 19.0 months, p = 0.768). However, in the exploratory subgroup analysis of infratentorial with/without supratentorial metastases (n = 96), the WBRT-SIB group showed a significantly better OS than the WBRT-alone group (24.6 vs.17.2 months, p = 0.040). Furthermore, the Cox proportional hazard model of this subgroup revealed that WBRT-SIB (p = 0.039) and systemic therapy after radiotherapy (p = 0.002) were independent prognostic factors for OS. There was no difference in the incidence of grade 3-4 acute brain radiation reactions between the two groups (24.6% vs. 17.4%, p = 0.290).

CONCLUSION

WBRT-SIB is a promising strategy for patients with BM. Compared to WBRT alone, WBRT-SIB can significantly prolong the intracranial PFS (including local and distant PFS). Additionally, while WBRT-SIB did not improve OS in the entire cohort, the OS benefit for patients with BM accompanied by infratentorial involvement warrants further exploration.

摘要

背景

尽管全脑放疗同步推量（WBRT-SIB）在临床上的应用日益增多，但其与单纯全脑放疗（单纯WBRT）相比的有效性尚不清楚。为了研究这两种方法在颅内控制和总生存期（OS）方面的差异，我们对脑转移瘤（BM）患者进行了匹配比较。

方法

2015年1月1日至2019年12月31日，共有245例BM患者符合纳入标准，其中154例接受单纯WBRT（30 Gy/10次分割），91例接受WBRT-SIB（40 - 50 Gy/10次分割）。采用1:1倾向评分匹配法选择基线特征均衡的患者。使用Kaplan-Meier法、Log-rank检验和Cox比例风险回归模型分析颅内控制和OS情况。

结果

138例患者被匹配到WBRT-SIB组和单纯WBRT组。其中，113例（81.9%）患者的BM原发于肺部，124例（89.9%）患者有3个以上颅内病灶。放疗开始后，WBRT-SIB组和单纯WBRT组的2年颅内无进展生存期（iPFS）、局部无进展生存期（iLPFS）和远处无进展生存期（iDPFS）分别为46.2%和24.5%（p = 0.017）、49.4%和29.8%（p = 0.033）、68.6%和54.4%（p = 0.040）。OS无显著差异（22.2个月对19.0个月，p = 0.768）。然而，在幕下有无幕上转移的探索性亚组分析中（n = 96），WBRT-SIB组的OS显著优于单纯WBRT组（24.6个月对17.2个月，p = 0.040）。此外，该亚组的Cox比例风险模型显示，WBRT-SIB（p = 0.039）和放疗后全身治疗（p = 0.002）是OS的独立预后因素。两组3 - 4级急性脑放射反应发生率无差异（24.6%对17.4%，p = 0.290）。