Yan Pengwei, Wang Changzhai, Tuoligan Duixian, Kabinuer Aji, Li Sheng, Song Xue, Zhu Huanfeng
Department of Radiation Oncology, Jiangsu Cancer Hospital, the Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, No. 42 Baiziting, Xuanwu District, Nanjing, 210009, P.R. China.
Department of Radiation Oncology, the Affiliated Kezhou People's Hospital of Nanjing Medical University & People's Hospital of Kizilesu Kirgiz Autonomous Prefecture, Kezhou, 845350, Xinjiang, P.R. China.
Open Life Sci. 2025 Sep 1;20(1):20251102. doi: 10.1515/biol-2025-1102. eCollection 2025.
Brain metastases (BMs) usually occur in the advanced stage of cancers with a poor prognosis. This study aimed to compare the clinical efficacy and effects on cognitive function of immunotherapy combined with whole brain radiotherapy (WBRT) and immunotherapy combined with WBRT plus sequential integrated boost (SEB) in the treatment of multiple BMs. A total of 57 patients diagnosed with BMs were included in Kezhou People's Hospital Affiliated to Nanjing Medical University between 2021 and 2023. Patients were allocated into the WBRT group ( = 27) and the WBRT + SEB group ( = 30) based on whether to receive a boost. The WBRT + SEB group showed a higher complete response rate and objective response rate compared to the WBRT group (26.7 vs 14.8%, 90.0 vs 66.7%) (all < 0.05). The two groups had a median overall survival (OS) time of 11.2 months (95% confidence interval [CI]: 9.3-13.1) and 9.4 months (95% CI: 6.2-12.6), respectively, with no statistically significant difference ( = 0.176). There was no difference in the levels of mini-mental state examination score at 1, 3, and 6 months, as well as the risk of adverse events, after WBRT between the two groups. In conclusion, SEB may improve the remission rate of lesions but not prolong the OS time. The boost would neither increase serious side effects nor would it aggravate cognitive impairment caused by WBRT.
脑转移瘤（BMs）通常发生在癌症晚期，预后较差。本研究旨在比较免疫治疗联合全脑放疗（WBRT）与免疫治疗联合WBRT加序贯调强放疗（SEB）治疗多发性BMs的临床疗效及对认知功能的影响。2021年至2023年期间，南京医科大学附属泰州人民医院共纳入57例确诊为BMs的患者。根据是否接受调强放疗，将患者分为WBRT组（n = 27）和WBRT + SEB组（n = 30）。与WBRT组相比，WBRT + SEB组的完全缓解率和客观缓解率更高（26.7%对14.8%，90.0%对66.7%）（均P < 0.05）。两组的中位总生存期（OS）分别为11.2个月（95%置信区间[CI]：9.3 - 13.1）和9.4个月（95% CI：6.2 - 12.6），差异无统计学意义（P = 0.176）。两组在WBRT后1、3和6个月的简易精神状态检查评分水平以及不良事件风险方面无差异。总之，SEB可能提高病变缓解率，但不会延长OS时间。调强放疗既不会增加严重副作用，也不会加重WBRT引起的认知障碍。
