SINGLE-DOSE VERSUS FRACTIONATED STEREOTACTIC RADIOTHERAPY FOR BRAIN METASTASES
SINGLE-DOSE VERSUS FRACTIONATED STEREOTACTIC RADIOTHERAPY FOR BRAIN METASTASES
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DOI：
10.1016/j.ijrobp.2010.05.033
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发表时间：
2011-10-01
影响因子：
7
通讯作者：
Lee, Seung Hoon
中科院分区：
文献类型：
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作者：
Kim, Yeon-Joo;Cho, Kwan Ho;Lee, Seung Hoon
目的：通过比较单次剂量放射外科（SRS）和分次立体定向放射治疗（FSRT）两种不同治疗方案，评价立体定向放射治疗脑转移瘤的疗效。58例患者接受SRS治疗，40例患者接受FSRT治疗。分次立体定向放射治疗用于大病灶或位于关键结构附近的病灶。SRS组的中位剂量为20戈伊，FSRT组的中位剂量为36戈伊，分6次治疗。结果：所有患者的中位随访期为7个月，中位生存期为7个月，SRS组的中位生存期为6个月，FSRT组的中位生存期为8个月（p = 0.89）。SRS组6个月和1年的局部无进展生存率（LPFS）分别为81%和71%，FSRT组分别为97%和69%（p = 0.31）。尽管FSRT用于大病变和不良部位病变，但LPFS并不劣于SRS。SRS组的毒性发生率高于FSRT组（17%对5%，p = 0.05）。因为与SRS治疗的患者相比，FSRT治疗的患者表现出相似的生存时间和LPFS率，毒性风险较低，尽管FSRT用于大病变和不良部位病变，我们发现FSRT对于具有大损伤或位于关键结构附近的损伤的患者特别有益。需要进一步研究以确定最佳剂量/分次。(C)2011 Elsevier Inc.
Purpose: To evaluate the efficacy of stereotactic radiotherapy in patients with brain metastases by comparing two different treatment regimens, single-dose radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT).Methods and Materials: Between November 2003 and December 2008, 98 patients with brain metastases were included. Fifty-eight patients were treated with SRS, and forty were treated with FSRT. Fractionated stereotactic radiotherapy was used for large lesions or lesions located near critical structures. The median doses were 20 Gy for the SRS group and 36 Gy in 6 fractions for the FSRT group.Results: With a median follow-up period of 7 months, the median survival was 7 months for all patients, with a median of 6 months for the SRS group and 8 months for the FSRT group (p = 0.89). Local progression free survival (LPFS) rates at 6 months and 1 year were 81% and 71%, respectively, for the SRS group and 97% and 69%, respectively, for the FSRT group (p = 0.31). Despite the fact that FSRT was used for large lesions and lesions in adverse locations, LPFS was not inferior to SRS. Toxicity was more frequently observed in the SRS group than in the FSRT group (17% vs. 5%, p = 0.05).Conclusions: Because patients treated with FSRT exhibited similar survival times and LPFS rates with a lower risk of toxicity in comparison to those treated with SRS, despite the fact that FSRT was used for large lesions and lesions in adverse locations, we find that FSRT can particularly be beneficial for patients with large lesions or lesions located near critical structures. Further investigation is warranted to determine the optimal dose/fractionation. (C) 2011 Elsevier Inc.