Value of whole brain re-irradiation for brain metastases - Single centre experience
Value of whole brain re-irradiation for brain metastases - Single centre experience
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DOI：
10.1016/j.clon.2007.06.001
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发表时间：
2007-09-01
影响因子：
3.4
通讯作者：
Laperriere, N.
中科院分区：
文献类型：
--
作者：
Sadikov, E.;Bezjak, A.;Laperriere, N.
目的：在已发表的研究中，关于重复全脑放疗（WBRT）对既往接受过放疗的脑转移瘤的作用存在争议。我们的回顾性研究的目的是记录在玛嘉烈医院的做法，就进行性或复发性脑转移性疾病的患者的reiradiation后，最初WBRT.Materials和方法：一个全面的计算机化的数据库，用于识别脑转移瘤治疗的患者超过一个疗程的WBRT在1997年和2003年之间。72例患者接受了WBRT治疗脑转移瘤，并在随后接受了WBRT复治。结果：中位年龄为56.5岁。最常见的原发部位是肺（51例患者）和乳腺（17例患者）。初始放疗最常用的剂量为20Gy/5次（62例患者）。最常见的再照射剂量为25戈伊/10次（22例）、20戈伊/10次（12例）、15戈伊/5次（11例）和20戈伊/8次（10例）。根据随访临床记录判断，31%的患者在再次照射后出现部分临床反应; 27%保持稳定; 32%在再次照射后恶化。重新开始治疗时东部肿瘤协作组体能状态为0 - 1的患者生存时间更长。在应答者中，平均应答持续时间为5.1个月。再照射后的中位生存期为4.1个月。据报道，一名患者在无进展生存5个月后出现记忆障碍和垂体功能不全。结论：对于精心选择的患者，重复放疗可能是一种有用的治疗方法。存活率提高，系统性改善。尽管有更多的患者可以选择重复WBRT治疗复发性脑转移瘤，但仍需要前瞻性研究来更清楚地记录其结局。
Aims: There is controversy in published studies regarding the role of repeat whole brain radiation (WBRT) for previously irradiated brain metastases. The aim of our retrospective study was to document the practice at Princess Margaret Hospital with respect to the re-irraidiation of patients with progressive or recurrent brain metastatic disease after initial WBRT.Materials and methods: A comprehensive computerised database was used to identify patients treated for brain metastases with more than one course of WBRT between 1997 and 2003. Seventy-two patients were treated with WBRT for brain metastases and retreated with WBRT at a later date. The records of these patients were reviewed.Results: The median age was 56.5 years. The most common primary sites were lung (51 patients) and breast (17 patients). The most frequent dose used for the initial radiotherapy was 20Gy/5 fractions (62 patients). The most common doses of re-irradiation were 25 Gy/10 fractions (22 patients), 20 Gy/10 fractions (12 patients), 15Gy/5fractions (11 patients) and 20 Gy/8 fractions (10 patients). Thirty-one per cent of patients experienced a partial clinical response after re-irradiation, as judged by follow-up clinical notes; 27% remained stable; 32% deteriorated after re-irradiation. Patients who had Eastern, Cooperative Oncology Group performance status 0-1 at the time of retreatment lived longer. In responders, the mean duration of response was 5.1 months. The median survival after re-irradiation was 4.1 months. One patient was reported as having memory impairment and pituitary insufficiency after 5 months of progression-free survival.Conclusion: Repeat radiotherapy may be a useful treatment in carefully selected patients. With increased survival and better systemic. options for patients with metastatic disease, more patients may be candidates for consideration of repeat WBRT for recurrent brain metastases, but prospective studies are needed to more clearly document their outcomes.