Does immunotherapy increase the rate of radiation necrosis after radiosurgical treatment of brain metastases?
Does immunotherapy increase the rate of radiation necrosis after radiosurgical treatment of brain metastases?
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DOI：
10.3171/2015.6.jns142763
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发表时间：
2016-07-01
影响因子：
4.1
通讯作者：
Chiang, Veronica L.
中科院分区：
文献类型：
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作者：
Colaco, Rovel J.;Martin, Pierre;Chiang, Veronica L.
目的放射性坏死(RN)或其影像表现与治疗相关的影像改变(TIC)是脑内对高剂量辐射的一种炎性反应。作者试图调查免疫治疗增加脑转移瘤立体定向伽玛刀(GK)放射外科治疗后发生RN/TIC风险的假设。方法对2006-2012年间180例脑转移瘤GK手术患者进行研究。他们接受的全身治疗分为细胞毒性化疗(CT)、靶向治疗(TT)或免疫治疗(IT)。与GK治疗相关的系统治疗的时间也被记录下来。根据接受的系统治疗类型，用Logistic回归计算发生RN的几率。在180例患者中，39例(21.7%)发展为RN/TIC。37.5%(12/32)接受单纯IT治疗，16.9%(14/83)接受CT治疗，25.0%(5/20)接受TT治疗。发生RN/TIC的患者的中位总生存期显著延长(分别为23.7个月和9.9个月)。单纯接受IT治疗的患者RN/TRIC显著增加(OR 2.40[95%CI 1.06~5.44]；p=0.03)，而接受任何CT检查的患者发生RN/TRIC的风险较低(OR 0.38[95%CI 0.18~0.78]；p=0.01)。接受IT的患者和接受CT的患者发生RN/TIC的时间没有差异。结论立体定向放射外科术后单独接受IT的患者RN/TIC的发生率可能高于单独接受CT或TT的患者，而接受任何CT实际上可能对RN/TIC具有保护作用。随着免疫疗法使用的增加，与化疗时代相比，RN/TIC的比率可能会增加。
OBJECTIVE Radiation necrosis (RN), or its imaging equivalent, treatment-related imaging changes (TRIC), is an inflammatory reaction to high-dose radiation in the brain. The authors sought to investigate the hypothesis that immunotherapy increases the risk of developing RN/TRIC after stereotactic Gamma Knife (GK) radiosurgery for brain metastases.METHODS A total of 180 patients who underwent GK surgery for brain metastases between 2006 and 2012 were studied. The systemic therapy they received was classified as cytotoxic chemotherapy (CT), targeted therapy (TT), or immunotherapy (IT). The timing of systemic therapy in relation to GK treatment was also recorded. Logistic regression was used to calculate the odds of developing RN according to type of systemic therapy received.RESULTS The median follow-up time was 11.7 months. Of 180 patients, 39 (21.7%) developed RN/TRIC. RN/TRIC rates were 37.5% (12 of 32) in patients who received IT alone, 16.9% (14 of 83) in those who received CT only, and 25.0% (5 of 20) in those who received TT only. Median overall survival was significantly longer in patients who developed RN/TRIC (23.7 vs 9.9 months, respectively). The RN/TRIC rate was increased significantly in patients who received IT alone (OR 2.40 [95% CI 1.06-5.44]; p = 0.03), whereas receipt of any CT was associated with a lower risk of RN/TRIC (OR 0.38 [95% CI 0.18-0.78]; p = 0.01). The timing of development of RN/TRIC was not different between patients who received IT and those who received CT.CONCLUSIONS Patients who receive IT alone may have an increased rate of RN/TRIC compared with those who receive CT or TT alone after stereotactic radiosurgery, whereas receiving any CT may in fact be protective against RN/TRIC. As the use of immunotherapies increases, the rate of RN/TRIC may be expected to increase compared with rates in the chemotherapy era.