Stereotactic Radiosurgery to More Than 10 Brain Metastases: Evidence to Support the Role of Radiosurgery for Ideal Hippocampal Sparing in the Treatment of Multiple Brain Metastases.
Stereotactic Radiosurgery to More Than 10 Brain Metastases: Evidence to Support the Role of Radiosurgery for Ideal Hippocampal Sparing in the Treatment of Multiple Brain Metastases.
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DOI：
10.1016/j.wneu.2019.11.089
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发表时间：
2020-03
影响因子：
2
通讯作者：
Braunstein SE
中科院分区：
文献类型：
--
作者：
Susko MS;Garcia MA;Ma L;Nakamura JL;Raleigh DR;Fogh S;Theodosopoulos P;McDermott M;Sneed PK;Braunstein SE
脑转移是一种常见的疾病，有文献支持立体定向放射手术（SRS）治疗有限数量的脑转移，而不是全脑放疗（WBRT）。对于SRS在≥10个脑转移患者中的作用了解较少。回顾了1999年3月至2016年12月期间接受SRS治疗至≥10例脑转移瘤且未并发WBRT的患者。分析了总生存率、治疗后病变无进展（FFP）、无新转移（FFNMs）和不良辐射效应。回顾性地生成接受前置SRS治疗的患者的海马体积，以评估剂量体积指标。共有143例患者被确定，其中75例患者接受了前期SRS， 68例患者在先前的WBRT后接受了挽救性治疗。每位患者中位病变数为13个（四分位间距[IQR]， 11-17）。治疗总容积中位数为4.1 cm3 （IQR, 2.0-9.9 cm3）。前期治疗和救助治疗的中位12个月FFP分别为96.8%（95%可信区间[CI]， 95.5-98.1）和83.6% (95% CI, 79.9-87.5) （P < 0.001）。前期和救助期SRS的12个月FFNMs分别为18.8% （95% CI, 10.9-32.3）和19.2% (95% CI, 9.7-37.8) （P = 0.90）。海马平均剂量为150 cGy （IQR, 100-202 cGy）。在治疗bbb10颅内转移患者时，无论是在前期治疗还是在抢救治疗中，局部控制率都可以达到很高的水平。在接受治疗的患者中，海马保留很容易实现预期的高新转移灶率。
Brain metastases are a common occurrence, with literature supporting the treatment of a limited number of brain metastases with stereotactic radiosurgery (SRS), as opposed to whole brain radiotherapy (WBRT). Less well understood is the role of SRS in patients with ≥10 brain metastases. Patients treated with SRS to ≥10 brain metastases without concurrent WBRT between March 1999 and December 2016 were reviewed. Analysis was performed for overall survival, treated lesion freedom from progression (FFP), freedom from new metastases (FFNMs), and adverse radiation effect. Hippocampal volumes were retrospectively generated in patients treated with up-front SRS for evaluation of dose volume metrics. A total of 143 patients were identified with 75 patients having up-front SRS and 68 patients being treated as salvage therapy after prior WBRT. The median number of lesions per patient was 13 (interquartile range [IQR], 11–17). Median total volume of treatment was 4.1 cm3 (IQR, 2.0–9.9 cm3). The median 12-month FFP for up-front and salvage treatment was 96.8% (95% confidence interval [CI], 95.5–98.1) and 83.6% (95% CI, 79.9–87.5), respectively (P < 0.001). Twelve-month FFNMs for up-front and salvage SRS was 18.8% (95% CI, 10.9–32.3) versus 19.2% (95% CI, 9.7–37.8), respectively (P = 0.90). The mean hippocampal dose was 150 cGy (IQR, 100–202 cGy). Excellent rates of local control can be achieved when treating patients with >10 intracranial metastases either in the up-front or salvage setting. Hippocampal sparing is readily achievable with expected high rates of new metastatic lesions in treated patients.
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DOI：
10.1016/s1470-2045(16)30053-5
发表时间：
2016-07
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Goldberg SB;Gettinger SN;Mahajan A;Chiang AC;Herbst RS;Sznol M;Tsiouris AJ;Cohen J;Vortmeyer A;Jilaveanu L;Yu J;Hegde U;Speaker S;Madura M;Ralabate A;Rivera A;Rowen E;Gerrish H;Yao X;Chiang V;Kluger HM
通讯作者：
Kluger HM
影响因子：
120.7
作者：
Aoyama, Hidefumi;Shirato, Hiroki;Kobashi, Gen
通讯作者：
Kobashi, Gen
影响因子：
3.3
作者：
Garcia, Michael A.;Anwar, Mekhail;Braunstein, Steve E.
通讯作者：
Braunstein, Steve E.
影响因子：
1.6
作者：
Kim, Chang-Hyun;Im, Yong-Seok;Lee, Jung-Il
通讯作者：
Lee, Jung-Il
影响因子：
51.1
作者：
Yamamoto, Masaaki;Serizawa, Toru;Tsuchiya, Kazuhiro
通讯作者：
Tsuchiya, Kazuhiro