Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery.
Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery.
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采用 5 分次立体定向放射外科治疗的完整脑转移瘤和已切除脑转移瘤患者的结果。
DOI：
10.1016/j.adro.2022.101166
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发表时间：
2023-03
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
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作者：
低分割立体定向放射外科(HF-SRS)加或不加手术切除可能是治疗较大或有症状的脑转移瘤(BMS)的首选方法。在此，我们报告了HF-SRS的临床结果和预测因素。回顾分析2008-2018年间因完整(IHF-SRS)或切除(RHF-SRS)BMS而行HF-SRS的患者。基于直线加速器的图像引导的HF-SRS由5个分割组成，每个分割的剂量分别为5、5.5或6Gy.计算局部进展时间(LP)、远程脑进展时间(DBP)和总生存期(OS)。COX模型评估临床因素对OS的影响。Fine和Gray的竞技项目累积关联模型检验了各因素对LP和DBP的影响。确定软脑膜病(LMD)的发生情况。Logistic回归分析了LMD的预测因素。在445名患者中，中位年龄为63.5岁；87%的患者具有卡诺夫斯基功能状态≥70。53%的患者接受了手术切除，75%的患者接受了每次5GY的治疗。接受BMS切除的患者有更高的Karnofsky功能状态(90-100，41vs30%)，较少的颅外疾病(25vs13%)，以及较少的BMS(多发性，32vs67%)。正常BMS的中位直径为3.0 cm(四分位数范围1.8~3.6 cm)，切除BMS的中位直径为4.6 cm(四分位数范围3.9~5.5 cm)。中位OS在IHF-SRS后为5.1个月(95%可信区间，4.3-6.0)，在RHF-SRS后为12.8个月(95%可信区间，10.8-16.2)(P<；0.01)。18个月时LP累积发生率为14.5%(95%CI，11.4-18.0%)，与IFR-SRS后总GTV(风险比，1.12；95%CI，1.05-1.20)显著相关，与所有患者的BMS复发有关(风险比，2.28；95%CI，1.01-5.15)。RHF-SRS组的累积DBP发生率显著高于IHF-SRS组(P<0.01)，其24个月的累积发生率分别为50.0%(95%CI，43.3-56.3)和35.7%(95%CI，29.2-42.2)。17.1%的RHF-SRS和8.1%的IHF-SRS患者出现LMD(共57次事件；33%为结节状，67%为弥漫性)(优势比为2.46；95%可信区间为1.34-4.53)。发生任何放射性坏死和2级以上放射性坏死事件的比例分别为14%和8%。HF-SRS在术后和完整环境下显示良好的LC和放射性坏死率。相应的LMD和RN比率与其他研究结果相似。
Hypofractionated stereotactic radiosurgery (HF-SRS) with or without surgical resection is potentially a preferred treatment for larger or symptomatic brain metastases (BMs). Herein, we report clinical outcomes and predictive factors following HF-SRS. Patients undergoing HF-SRS for intact (iHF-SRS) or resected (rHF-SRS) BMs from 2008 to 2018 were retrospectively identified. Linear accelerator-based image-guided HF-SRS consisted of 5 fractions at 5, 5.5, or 6 Gy per fraction. Time to local progression (LP), time to distant brain progression (DBP), and overall survival (OS) were calculated. Cox models assessed effect of clinical factors on OS. Fine and Gray's cumulative incidence model for competing events examined effect of factors on LP and DBP. The occurrence of leptomeningeal disease (LMD) was determined. Logistic regression examined predictors of LMD. Among 445 patients, median age was 63.5 years; 87% had Karnofsky performance status ≥70. Fifty-three % of patients underwent surgical resection, and 75% received 5 Gy per fraction. Patients with resected BMs had higher Karnofsky performance status (90-100, 41 vs 30%), less extracranial disease (absent, 25 vs 13%), and fewer BMs (multiple, 32 vs 67%). Median diameter of the dominant BM was 3.0 cm (interquartile range, 1.8-3.6 cm) for intact BMs and 4.6 cm (interquartile range, 3.9-5.5 cm) for resected BMs. Median OS was 5.1 months (95% confidence interval [CI], 4.3-6.0) following iHF-SRS and 12.8 months (95% CI, 10.8-16.2) following rHF-SRS (P < .01). Cumulative LP incidence was 14.5% at 18 months (95% CI, 11.4-18.0%), significantly associated with greater total GTV (hazard ratio, 1.12; 95% CI, 1.05-1.20) following iFR-SRS, and with recurrent versus newly diagnosed BMs across all patients (hazard ratio, 2.28; 95% CI, 1.01-5.15). Cumulative DBP incidence was significantly greater following rHF-SRS than iHF-SRS (P = .01), with respective 24-month rates of 50.0 (95% CI, 43.3-56.3) and 35.7% (95% CI, 29.2-42.2). LMD (57 events total; 33% nodular, 67% diffuse) was observed in 17.1% of rHF-SRS and 8.1% of iHF-SRS cases (odds ratio, 2.46; 95% CI, 1.34-4.53). Any radionecrosis and grade 2+ radionecrosis events were observed in 14 and 8% of cases, respectively. HF-SRS demonstrated favorable rates of LC and radionecrosis in postoperative and intact settings. Corresponding LMD and RN rates were comparable to those of other studies.
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DOI：
10.1186/1748-717x-6-48
发表时间：
2011-05-15
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
Minniti G;Clarke E;Lanzetta G;Osti MF;Trasimeni G;Bozzao A;Romano A;Enrici RM
通讯作者：
Enrici RM
DOI：
10.1016/j.ijrobp.2020.10.034
发表时间：
2021-04-14
影响因子：
7
作者：
Redmond, Kristin J.;Gui, Chengcheng;Kleinberg, Lawrence R.
通讯作者：
Kleinberg, Lawrence R.
DOI：
10.1016/j.ijrobp.2014.09.004
发表时间：
2015-01-01
影响因子：
7
作者：
Kirkpatrick, John P.;Wang, Zhiheng;Yin, Fang-Fang
通讯作者：
Yin, Fang-Fang
DOI：
10.1016/j.ijrobp.2010.05.033
发表时间：
2011-10-01
影响因子：
7
作者：
Kim, Yeon-Joo;Cho, Kwan Ho;Lee, Seung Hoon
通讯作者：
Lee, Seung Hoon
影响因子：
1.3
作者：
Feuvret, L.;Vinchon, S.;Mazeron, J-J
通讯作者：
Mazeron, J-J