Radiosurgery for re-irradiation of brain metastasis:: results in 54 patients
Radiosurgery for re-irradiation of brain metastasis:: results in 54 patients
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DOI：
10.1016/s0167-8140(01)00359-0
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发表时间：
2001-07-01
影响因子：
5.7
通讯作者：
Mazeron, JJ
中科院分区：
文献类型：
--
作者：
Noël, G;Proudhom, MA;Mazeron, JJ
目的：为了评估局部区域控制和生存的概率，以及治疗相关的毒性，放射外科治疗脑转移瘤的结果出现在以前照射的territory.Patients和方法：在1994年1月至2000年3月，54例连续患者提出97转移复发后全脑放疗（WBRT）与立体定向放射治疗。WBRT结束与放射外科手术之间的中位间隔为9个月（范围2-70）。中位年龄为53岁（24-80岁），中位Karnofski体能状态（KPS）为70（60-100）。47名患者接受了1次放射外科手术，5名患者接受了2次放射外科手术，2名患者接受了3次放射外科手术。中位转移直径和体积分别为21 mm（6-59）和1.2 cc（0.1-95.2）。在局部麻醉下应用Leksell立体定向头架（Leksell Model G，Elektra，Instrument，Tucker，GA）。通过机架安装的线性加速器（linacs）（Saturne，General Electric）递送辐照。中位最小照射剂量16.2戈伊（11.8 ~ 23），中位最大照射剂量21.2戈伊（14-42）。5例转移瘤复发。1年和2年转移局控率分别为91.3%和84%，1年和2年脑控率分别为65%和57%。6例死于脑转移，3例死于软脑膜癌病。1年和2年总生存率分别为31%和28%。单因素分析显示，KPS评分、RPA分级、SIR评分和WBRT至放射外科治疗的间隔时间是影响总生存期和脑无病生存期的预后因素。多因素分析显示，RPA是影响总生存率和脑无病生存率的独立因素，WBRT与放射外科手术间隔时间超过14个月与脑无病生存率延长相关。副作用很小，只有2例头痛和2级alabol.Conclusion：挽救性放射外科治疗转移瘤复发后全脑照射是一种有效的和准确的治疗，可建议患者与KPS > 70和原发肿瘤控制或惰性。我们建议，剂量不超过14戈伊应交付的等剂量代表70%的最大剂量，因为局部控制观察率与以前发表的文献中的上限剂量和副作用是最小的。(C)2001爱思唯尔科学爱尔兰有限公司保留所有权利。
Purpose: To evaluate in terms of probabilities of local-regional control and survival, as well as of treatment-related toxicity, results of radiosurgery for brain metastasis arising in previously irradiated territory.Patients and methods: Between January 1994 and March 2000, 54 consecutive patients presenting with 97 metastases relapsing after whole brain radiotherapy (WBRT) were treated with stereotactic radiotherapy. Median interval between the end of WBRT and radiosurgery was 9 months (range 2-70). Median age was 53 years (24-80), and median Karnofski performance status (KPS) 70 (60-100). Forty-seven patients had one radiosurgery, five had two and two had three. Median metastasis diameter and volume were 21 mm (6-59) and 1.2 cc (0.1-95.2), respectively. A Leksell stereotactic head frame (Leksell Model G, Elektra, Instrument, Tucker, GA) was applied under local anesthesia. Irradiation was delivered by a gantry mounted linear accelerator (linacs) (Saturne, General Electric). Median minimal dose delivered to the gross disease was 16.2 Gy (11.8-23), and median maximal dose 21.2 Gy (14-42).Results: Median follow-up was 9 months (1-57). Five metastases recurred. One- and 2-year metastasis local control rates were 91.3 and 84% and 1- and 2-year brain control rates were 65 and 57%, respectively. Six patients died of brain metastasis evolution, and three of leptomeningeal carcinomatosis. One- and 2-year overall survival rates were 31 and 28%, respectively. According to univariate analysis, KPS, RPA class, SIR score and interval between WBRT and radiosurgery were prognostic factors of overall survival and brain free-disease survival. According to multivariate analysis, RPA was an independent factor of overall survival and brain free-disease survival, and the interval between WBRT and radiosurgery longer than 14 months was associated with longer brain free-disease survival. Side effects were minimal, with only two cases of headaches and two of grade 2 alopecia.Conclusion: Salvage radiosurgery of metastasis recurring after whole brain irradiation is an effective and accurate treatment which could be proposed to patients with a KPS > 70 and a primary tumour controlled or indolent. We recommend that a dose not exceeding 14 Gy should be delivered to an isodose representing 70% of the maximal dose since local control observed rate was similar to that previously published in literature with upper dose and side effects were minimal. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.