POSTOPERATIVE RADIATION FOR LUNG-CANCER METASTATIC TO THE BRAIN
POSTOPERATIVE RADIATION FOR LUNG-CANCER METASTATIC TO THE BRAIN
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DOI：
10.1200/jco.1994.12.11.2340
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发表时间：
1994-11-01
影响因子：
45.3
通讯作者：
BURT, M
中科院分区：
文献类型：
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作者：
ARMSTRONG, JG;WRONSKI, M;BURT, M
目的：虽然切除单个脑转移瘤和术后全脑放射治疗（WBRT）可提高生存率，但与单独使用WBRT治疗相比，脑转移瘤切除后术后WBRT的价值存在争议。我们分析了最大的肺癌患者切除脑转移瘤的报告系列，以评估术后WBRT.Materials和方法的影响：1974年至1989年，185例非小细胞肺癌（NSCLC）进行切除脑转移瘤。排除了接受术前WBRT的患者（23%，42/185）。其余患者分为A组（无WBRT; n = 32）、B组（接受WBRT且与A组匹配的患者; n = 32）和C组（所有其他WBRT患者; n = 79）。大多数患者接受术后剂量为30戈伊，分10次。结果：A、B、C三组患者的5年生存率分别为12%、8%、16%。A组中38%的患者、B组中47%的患者和C组中42%的患者发生了总体脑衰竭。WBRT的使用（A组v B + C组）对生存率或总体脑衰竭率没有明显影响。特别是，当将B组与A组进行比较时，这些参数均未得到改善。局灶性失败（定义为脑转移瘤切除部位附近的脑内失败）的发生率如下：A组，34%（32例中的11例）; B + C组，23%（111例中的25例）（P = 0.07）。WBRT显著降低了腺癌患者的局灶性衰竭（A组，33% [8/24]; B + C组，14% [11/79]; P = 0.05）。非局灶性失败（解剖学上与切除的转移瘤不同）在A组中发生率为9%（3/32），在B + C组中为21%（23/111）（P = 0.07）。术后WBRT（如本系列中所用）仅对脑转移灶的局灶控制有影响，且该影响具有临界意义，缺乏确定性获益支持需要进行随机试验以测试辅助术后WBRT的价值。脑衰竭在所有三组患者中相对常见，这表明需要研究大于30戈伊的剂量。(C)1994年，美国临床肿瘤学会。
Purpose: Although resection of single brain metastases and postoperative whole-brain radiation therapy (WBRT) improves survival, compared with treatment using WBRT alone, the value of postoperative WBRT after resection of brain metastases is controversial. We analyzed the largest reported series of lung cancer patients with resected brain metastases to evaluate the impact of postoperative WBRT.Materials and Methods: Between 1974 and 1989, 185 patients with non-small cell lung cancer (NSCLC) underwent resection of brain metastases. Patients who had received preoperative WBRT (23%, 42 of 185) were excluded. The remaining patients were divided into group A (no WBRT; n = 32), group B (patients received WBRT and were prognostically matched to group A; n = 32), and group C (all other WBRT patients; n = 79). Most patients received postoperative doses of 30 Gy in 10 fractions. Higher doses were used in 16% of group B and 18% of group C patients.Results: Overall 5-year survival rates were as follows: group A, 12%; B, 8%; C, 16%. Overall brain failures occurred in 38% of patients in group A, 47% in group B, and 42% in group C. The use of WBRT (group A v groups B plus C) had no apparent impact on survival or on overall brain failure rates. In particular, no improvement in either of these parameters could be demonstrated when group B was compared with group A. Focal failure (defined as failure within the brain adjacent to the site of the resected brain metastases) occurred as follows: group A, 34% (11 of 32); groups B plus C, 23% (25 of 111) (P = .07). WBRT significantly reduced focal failure for patients with adenocarcinoma (group A, 33% [eight of 24]; groups B plus C, 14% [11 of 79]; (P = .05). Nonfocal failure (anatomically distinct from the resected metastasis) occurred in 9% of patients in group A (three of 32), 21% in groups B plus C (23 of 111) (P = .07).Conclusion: Long-term survival is possible when NSCLC brain metastases are resected. postoperative WBRT (as used in this series only had an impact on the focal control of brain metastases and this effect was of borderline significance, The lack of conclusive benefit supports the need for ongoing randomized trials to test the value of adjuvant postoperative WBRT. Brain failures were relatively common in all three groups of patients, which suggests that doses greeter than 30 Gy need to be studied. (C) 1994 by American Society of Clinical Oncology.