Gamma Knife Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer Patients Treated with Immunotherapy or Targeted Therapy.
Gamma Knife Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer Patients Treated with Immunotherapy or Targeted Therapy.
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伽玛刀放射治疗非小细胞肺癌患者脑转移的免疫治疗或靶向治疗。
DOI：
10.3390/cancers12123668
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发表时间：
2020-12-07
期刊：
影响因子：
5.2
通讯作者：
Frischer JM
中科院分区：
文献类型：
--
作者：
Cho A;Untersteiner H;Hirschmann D;Shaltout A;Göbl P;Dorfer C;Rössler K;Marik W;Kirchbacher K;Kapfhammer I;Zöchbauer-Müller S;Gatterbauer B;Hochmair MJ;Frischer JM
在有脑转移的非小细胞肺癌患者中，伽玛刀联合放射外科和免疫治疗或靶向治疗显示总存活率增加。伽玛刀联合免疫治疗或靶向治疗不会增加与放射外科相关的并发症。因此，对于脑转移的非小细胞肺癌患者，联合治疗似乎是一种安全有效的治疗方案。伽玛刀放射外科(GKRS)联合全身免疫治疗(IT)或靶向治疗(TT)是治疗非小细胞肺癌脑转移(BMS)的一种新方法。为了阐明联合应用IT或TT对GKRS术后预后的安全性和有效性，对496例非小细胞肺癌合并BMS患者进行了GKRS的回顾性研究。从最初的肺癌诊断到脑转移的诊断的中位数时间是一个月。初诊BM后的生存期显著长于预后BM评分所预测的生存期。首次伽玛刀治疗(GKRS1)后，中位生存期为9.9个月(95%CI=8.3~11.4)。并发IT或TT的患者在GKRS1后的生存期显著长于未并发IT或TT的患者(p<；0.001)。这些在生存率方面的显著差异在四个治疗组之间也是明显的，在根据Karnofsky工作状态量表(KPS)、递归分区分析(RPA)分级、性别和多个BMS进行调整后，这些显著差异仍然显著。我们所有的患者中约有一半(46%)在GKRS1后发生了新的远程BMS。值得注意的是，在GKRS1或GKRS1之后，与IT或TT相关的放射反应、放射性坏死或瘤内出血的发生率在统计学上没有显著差异。在NSCLC-BM患者中，联合使用GKRS和IT或TT可提高总存活率，而不增加与GKRS相关的并发症。因此，GKRS与IT或TT联合治疗似乎是一种安全有效的治疗方法，并强调了放射外科在现代BM治疗中的作用。
In non-small cell lung cancer patients with brain metastases, combined Gamma Knife radiosurgery and immunotherapy or targeted therapy showed an increase in overall survival. The combination of Gamma Knife radiosurgery and immunotherapy or targeted therapy did not increase complications related to radiosurgery. Therefore, the combined treatment seems to be a safe and powerful treatment option for non-small cell lung cancer patients with brain metastases. The combination of Gamma Knife radiosurgery (GKRS) and systemic immunotherapy (IT) or targeted therapy (TT) is a novel treatment method for brain metastases (BMs) in non-small cell lung cancer (NSCLC). To elucidate the safety and efficacy of concomitant IT or TT on the outcome after GKRS, 496 NSCLC patients with BMs, who were treated with GKRS were retrospectively reviewed. The median time between the initial lung cancer diagnosis and the diagnosis of brain metastases was one month. The survival after the initial BM diagnosis was significantly longer than the survival predicted by prognostic BM scores. After the first Gamma Knife radiosurgery treatment (GKRS1), the estimated median survival was 9.9 months (95% CI = 8.3–11.4). Patients with concurrent IT or TT presented with a significantly longer survival after GKRS1 than patients without IT or TT (p < 0.001). These significant differences in the survival were also apparent among the four treatment groups and remained significant after adjustment for Karnofsky performance status scale (KPS), recursive partitioning analysis (RPA) class, sex, and multiple BMs. About half of all our patients (46%) developed new distant BMs after GKRS1. Of note, no statistically significant differences in the occurrence of radiation reaction, radiation necrosis, or intralesional hemorrhage in association with IT or TT at or after GKRS1 were observed. In NSCLC-BM patients, the concomitant use of GKRS and IT or TT showed an increase in overall survival without increased complications related to GKRS. Therefore, the combined treatment with GKRS and IT or TT seems to be a safe and powerful treatment option and emphasizes the role of radiosurgery in modern BM treatment.
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影响因子：
4.9
作者：
Di Lorenzo R;Ahluwalia MS
通讯作者：
Ahluwalia MS
DOI：
10.1016/j.ijrobp.2007.06.074
发表时间：
2008-02-01
影响因子：
7
作者：
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DOI：
10.1016/s0360-3016(96)00619-0
发表时间：
1997-03-01
影响因子：
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通讯作者：
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DOI：
10.1016/j.ijrobp.2016.01.054
发表时间：
2016-06-01
影响因子：
7
作者：
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通讯作者：
Kleinberg, Lawrence R.
影响因子：
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作者：
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通讯作者：
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