Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases
Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases
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DOI：
10.1016/s0360-3016(99)00198-4
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发表时间：
1999-09-01
影响因子：
7
通讯作者：
Flickinger, JC
中科院分区：
文献类型：
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作者：
Kondziolka, D;Patel, A;Flickinger, JC
目的：多发性脑转移瘤是一种常见的健康问题，经常在癌症患者中被诊断出来。即使在全脑放射治疗（WBRT）治疗后，预后也很差，平均预期生存期不到6个月。回顾性系列立体定向放射外科手术在孤立性脑转移瘤患者的病例系列中显示了局部控制和生存益处。我们假设，放射外科加WBRT将提供改善局部脑肿瘤控制WBRT单独在患者有两个到四个braintransferation.Methods：患者有两个到四个脑转移瘤（所有小于或等于25毫米直径和已知的原发肿瘤类型）被随机分配到最初的脑肿瘤管理与WBRT单独（30戈伊在12个分数）或WBRT加放射外科。颅外癌的程度，MRI扫描的肿瘤直径，和功能状态被记录之前和之后的初始care.Results：该研究被停止在一个中期评估在60%的应计。27例患者随机分组（14例接受WBRT单药治疗，13例接受WBRT+放射外科治疗）。各组在年龄、性别、肿瘤类型、肿瘤数量和颅外病变程度方面匹配良好。单纯WBRT后1年局部失败率为100%，但加强放射外科治疗患者仅为8%。单独WBRT后至局部失败的中位时间为6个月（95%置信区间[CI]，3.5-8.5），而WBRT+放射外科治疗后为36个月（95% CI，15.6-57）（p = 0.0005）。放射外科组中至任何脑衰竭的中位时间有所改善（p = 0.002）。肿瘤控制不依赖于组织学（p = 0.85）、初始脑转移瘤数量（p = 0.25）或颅外疾病程度（p = 0.26）。单纯接受WBRT的患者中位生存期为7.5个月，而接受WBRT加放射外科治疗的患者生存期为11个月（p = 0.22）。生存率不依赖于组织学或肿瘤数量，但与颅外疾病的程度有关（p = 0.02）。有没有神经系统或全身发病率相关的立体定向radiosurgery.Conclusions：结合WBRT和放射外科手术的患者有两个到四个脑转移显着提高控制脑部疾病。单靠WBRT并不能为大多数患者提供持久有效的护理。(C)1999 Elsevier Science Inc.
Purpose: Multiple brain metastases are a common health problem, frequently diagnosed in patients with cancer. The prognosis, even after treatment with whole brain radiation therapy (WBRT), is poor with average expected survivals less than 6 months. Retrospective series of stereotactic radiosurgery have shown local control and survival benefits in case series of patients with solitary brain metastases. We hypothesized that radiosurgery plus WBRT would provide improved local brain tumor control over WBRT alone in patients with two to four brain metastases.Methods: Patients with two to four brain metastases (all less than or equal to 25 mm diameter and known primary tumor type) were randomized to initial brain tumor management with WBRT alone (30 Gy in 12 fractions) or WBRT plus radiosurgery. Extent of extracranial cancer, tumor diameters on MRI scan, and functional status were recorded before and after initial care.Results: The study was stopped at an interim evaluation at 60% accrual. Twenty-seven patients were randomized (14 to WBRT alone and 13 to WBRT plus radiosurgery). The groups were well matched to age, sex, tumor type, number of tumors, and extent of extracranial disease. The rate of local failure at 1 year was 100% after WBRT alone but only 8% in patients who had boost radiosurgery. The median time to local failure was 6 months after WBRT alone (95% confidence interval [CI], 3.5-8.5) in comparison to 36 months (95% CI, 15.6-57) after WBRT plus radiosurgery (p = 0.0005). The median time to any brain failure was improved in the radiosurgery group (p = 0.002). Tumor control did not depend on histology (p = 0.85), number of initial brain metastases (p = 0.25), or extent of extracranial disease (p = 0.26). Patients who received WBRT alone lived a median of 7.5 months, while those who received WBRT plus radiosurgery lived 11 months (p = 0.22). Survival did not depend on histology or number of tumors, but was related to extent of extracranial disease (p = 0.02). There was no neurologic or systemic morbidity related to stereotactic radiosurgery.Conclusions: Combined WBRT and radiosurgery for patients with two to four brain metastases significantly improves control of brain disease. WBRT alone does not provide lasting and effective care for most patients. (C) 1999 Elsevier Science Inc.