Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial
Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial
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DOI：
10.1016/s0140-6736(04)16250-8
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发表时间：
2004-05-22
期刊：
影响因子：
168.9
通讯作者：
Curran, WJ
中科院分区：
文献类型：
--
作者：
Andrews, DW;Scott, CB;Curran, WJ
在所有全身性癌症患者中，高达40%发生脑转移。我们的目的是评估是否立体定向放射外科手术提供任何治疗的好处，在一个随机多机构试验的放射治疗肿瘤组（RTOG）。方法1至3个新诊断的脑转移瘤患者被随机分配无论是全脑放射治疗（WBRT）或WBRT，然后立体定向放射外科手术加强。患者按转移灶数量和颅外疾病状态分层。主要结局是生存率;次要结果是肿瘤反应和局部率，总颅内复发率，死亡原因，和性能measurements.Findings从1996年1月至2001年6月，我们从55个参与RTOG机构招募了333例患者-167被分配WBRT和立体定向放射外科和164被分配WBRT单独。单变量分析显示，对于单发脑转移瘤患者，WBRT和立体定向放射外科治疗组具有生存优势（中位生存时间6.5 vs 4.9个月，p=0.0393）。在6个月随访时，立体定向手术组患者的Karnofsky体能状态（KPS）评分较单纯WBRT组患者更有可能稳定或改善（分别为43%和27%; p=0.03）。通过多变量分析，RPA 1级患者的生存率提高（p
Background Brain metastases occur in up to 40% of all patients with systemic cancer. We aimed to assess whether stereotactic radiosurgery provided any therapeutic benefit in a randomised multi-institutional trial directed by the Radiation Therapy Oncology Group (RTOG).Methods Patients with one to three newly diagnosed brain metastases were randomly allocated either whole brain radiation therapy (WBRT) or WBRT followed by stereotactic radiosurgery boost. Patients were stratified by number of metastases and status of extracranial disease. Primary outcome was survival; secondary outcomes were tumour response and local rates, overall intracranial recurrence rates, cause of death, and performance measurements.Findings From January, 1996, to June, 2001, we enrolled 333 patients from 55 participating RTOG institutions-167 were assigned WBRT and stereotactic radiosurgery and 164 were allocated WBRT alone. Univariate analysis showed that there was a survival advantage in the WBRT and stereotactic radiosurgery group for patients with a single brain metastasis (median survival time 6.5 vs 4.9 months, p=0.0393). Patients in the stereotactic surgery group were more likely to have a stable or improved Karnofsky Performance Status (KPS) score at 6 months' follow-up than were patients allocated WBRT alone (43% vs 27%, respectively; p=0.03). By multivariate analysis, survival improved in patients with an RPA class 1 (p