针对疾病进程中出现广泛脑转移的患者进行立体定向放射外科治疗。

Stereotactic radiosurgery for patients with extensive brain metastases across the disease course.

作者信息

Vaziri Tina, Liu I-Chia, Bettegowda Chetan, Croog Victoria, Jackson Christopher, Kamson David, Kleinberg Lawrence, Kut Carmen, Page Brandi, Mukherjee Debraj, Rincon-Torroella Jordina, Xu Risheng, Redmond Kristin J

机构信息

Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, USA.

Department of Neurosurgery, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, USA.

出版信息

J Neurooncol. 2025 Oct 16;176(1):24. doi: 10.1007/s11060-025-05256-x.

DOI:10.1007/s11060-025-05256-x

PMID:41102486

Abstract

PURPOSE

Stereotactic radiosurgery (SRS) is the standard of care for patients with limited brain metastases (BM). As systemic therapies prolong survival in metastatic disease, the role of SRS in patients with high intracranial disease burden remains undefined.

METHODS

Ninety patients with ≥15 SRS-treated BMs throughout their disease course between 2010 and 2023 were retrospectively reviewed. Outcomes-including overall survival (OS), freedom from whole-brain radiotherapy (FFW), intracranial control (IC), radiation necrosis (RN), and cumulative brain dose-were analyzed. Outcomes were estimated using the Kaplan-Meier method or Fine-Gray model. Univariable and multivariable regression identified prognostic factors.

RESULTS

The median number of BMs treated was 18 (IQR, 16-23) over a median of two SRS courses (IQR, 2-3). Primary tumor sites were lung (47.3%) and breast (22.6%). At initial SRS, 84.9% had ECOG ≤1/KPS > 70, and 33% had neurologic symptoms. With median follow-up of 15 months (range, 0-118), RN occurred in 8.9%; 13.3% developed leptomeningeal disease (median onset 12 months) with a higher risk observed in breast cancer (OR 4.20, 95% CI 1.19-14.87, p = 0.026). The mean cumulative whole-brain dose across all SRS courses was 5.3 Gy. One-year FFW was 75.1% and 68.8% did not undergo WBRT. Median OS was 17 months (95% CI 9.46-24.54), with 1-year OS of 64%.

CONCLUSIONS

SRS is safe and feasible for patients with a high BM burden, offering potential delay and avoidance of WBRT. Prospective, multi-institutional studies are warranted to validate these findings and further define the role of SRS in this population.

摘要

目的

立体定向放射外科治疗（SRS）是脑转移瘤（BM）数量有限患者的标准治疗方法。由于全身治疗可延长转移性疾病患者的生存期，SRS在颅内疾病负担高的患者中的作用仍不明确。

方法

回顾性分析了2010年至2023年期间在整个病程中接受≥15次SRS治疗的90例BM患者。分析了包括总生存期（OS）、免于全脑放疗（FFW）、颅内控制（IC）、放射性坏死（RN）和累积脑剂量等结果。使用Kaplan-Meier方法或Fine-Gray模型估计结果。单变量和多变量回归确定预后因素。

结果

治疗的BM中位数为18个（四分位间距，16-23），平均接受2次SRS疗程（四分位间距，2-3）。原发肿瘤部位为肺（47.3%）和乳腺（22.6%）。初次SRS时，84.9%的患者东部肿瘤协作组（ECOG）体能状态评分≤1/ Karnofsky评分（KPS）＞70，33%的患者有神经系统症状。中位随访15个月（范围，0-118个月），RN发生率为8.9%；13.3%的患者发生软脑膜疾病（中位发病时间12个月），乳腺癌患者的风险更高（比值比4.20，95%置信区间1.19-14.87，p=0.026）。所有SRS疗程的平均累积全脑剂量为5.3 Gy。1年FFW率为75.1%，68.8%的患者未接受全脑放疗（WBRT）。中位OS为17个月（95%置信区间9.46-24.54），1年OS率为64%。