Control of brain metastases from radioresistant tumors treated by stereotactic radiosurgery
Control of brain metastases from radioresistant tumors treated by stereotactic radiosurgery
复制标题
立体定向放射外科治疗抗放射肿瘤脑转移的控制
作者：
Andrew M Yaeh;T. Nanda;A. Jani;T. Rozenblat;Yasir H. Qureshi;S. Saad;J. Lesser;A. Lassman;S. Isaacson;M. Sisti;J. Bruce;G. Mckhann;T. Wang
肾细胞癌、肉瘤和黑色素瘤被认为是“放射抗性”肿瘤组织学。这些肿瘤的脑转移（BM）被认为不太可能使用全脑放疗（WBRT）中使用的相对低剂量进行控制。我们的目的是分析立体定向放射外科（SRS）对放射抵抗性原发肿瘤BM的局部控制和总生存率的疗效。我们回顾了2009年1月至2014年4月期间在哥伦比亚大学医学中心接受伽玛刀治疗BM的所有患者。所有患者均使用伽玛刀治疗系统进行治疗。从治疗计划中收集剂量数据，并将转移分类为放射抗性或非放射抗性。通过审查随访脑成像研究评估缓解，并根据RECIST进行分类。使用Kaplan-Meier方法计算局部控制和中位总生存期。总共分析了来自126名患者的373个肿瘤。在这些肿瘤中，49例（13.1%）起源于放射抗性癌症。放射抗性队列的总体局部控制率为89.8%，非放射抗性队列为90.1%。单变量和多变量分析表明，原发肿瘤的放射抗性状态对局部控制没有统计学显著影响，风险比分别为1.0（p = 1.0，95% CI 0.388-2.576）和0.954（p = 0.926，95% CI 0.349-2.603）。放射抵抗和非放射抵抗队列的中位总生存期均为20.0个月，p值为0.926。用GKRS治疗的放射抗性和非放射抗性原发性肿瘤的BM的局部控制没有显著差异。两个队列均显示出良好的缓解和局部控制，表明SRS前期或除WBRT外，可能是治疗放射抗性癌症BM的适当策略。两个队列的中位总生存期相等，表明局部控制的改善可能与长期生存期的改善相关。
Renal cell carcinoma, sarcoma, and melanoma are considered to be “radioresistant” tumor histologies. Brain metastases (BM) from these tumors are considered unlikely to be controlled using the relatively low doses used in whole brain radiotherapy (WBRT). Our objective was to analyze the efficacy of stereotactic radiosurgery (SRS) on local control and overall survival of BM from radioresistant primary tumors. We reviewed all patients who received Gamma Knife Radiosurgery (GKRS) for BM at Columbia University Medical Center between January 2009 and April 2014. All patients were treated using the Gamma Knife Perfexion System. Dosimetric data was collected from treatment plans and metastases were categorized as radioresistant or not. Response was assessed by reviewing follow-up brain imaging studies and classified according to RECIST. Local control and median overall survival were calculated using the Kaplan–Meier method. In total, 373 tumors were analyzed from 126 patients. Of these tumors, 49 (13.1 %) originated from radioresistant cancers. The overall local control rate in the radioresistant cohort was 89.8 and 90.1 % in the non-radioresistant cohort. Univariate and multivariate analyses demonstrated that radioresistance status of the primary tumor had no statistically significant effect on local control with hazard ratios of 1.0 (p = 1.0, 95 % CI 0.388–2.576) and 0.954 (p = 0.926, 95 % CI 0.349–2.603) respectively. Median overall survival for both radioresistant and non-radioresistant cohorts was 20.0 months, with a p value of 0.926. There was no significant difference in local control of BM from radioresistant and non-radioresistant primary tumors treated with GKRS. Both cohorts showed excellent response and local control, suggesting that SRS upfront or in addition to WBRT may be an appropriate strategy in the treatment of BM from radioresistant cancers. Median overall survival for both cohorts was equal, suggesting that improved local control may be associated with an improvement in long-term survival.
DOI：
10.1016/s0360-3016(98)00272-7
发表时间：
1998-10-01
影响因子：
7
作者：
Mori, Y;Kondziolka, D;Lunsford, LD
通讯作者：
Lunsford, LD