Combination laser interstitial thermal therapy plus stereotactic radiotherapy increases time to progression for biopsy-proven recurrent brain metastases.
Combination laser interstitial thermal therapy plus stereotactic radiotherapy increases time to progression for biopsy-proven recurrent brain metastases.
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DOI：
10.1093/noajnl/vdac086
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发表时间：
2022-01
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脑转移患者生存率的提高伴随着立体定向放射治疗（SRT）后肿瘤复发率的增加。激光间质热疗 (LITT) 已成为 SRT 失败的有效治疗方法，作为开放切除或重复 SRT 的替代方案。我们的目的是评估 LITT 继 SRT（LITT+SRT）治疗复发性脑转移瘤的疗效。对在学术医疗中心接受 SRT 后经活检证明脑转移复发的患者进行了一项多中心回顾性研究。根据“计划的 LITT+SRT”与“单独 LITT”与“单独重复 SRT”对患者进行分层。通过修改后的神经肿瘤脑转移反应评估 (RANO-BM) 标准确定指数病变进展。 55 名患者符合纳入标准，中位随访时间为 7.3 个月（范围：1.0-30.5），年龄为 60 岁（范围：37-86），卡诺夫斯基性能状态（KPS）为 80（范围：60-100），LITT/活检前对比增强体积为 5.7 cc（范围：0.7-19.4）。 38% 的患者接受了 LITT+SRT，45% 的患者仅接受 LITT，16% 的患者仅接受 SRT。 LITT+SRT 显着改善了出现病变进展的中位时间（29.8、7.5 和 3.7 个月 [P = 0.022]）。当在多变量分析中控制年龄时，接受 LITT+SRT 治疗的患者出现指数病变进展的可能性仍然显着降低 (P = .004)。这些数据表明，对于 SRT 失败后经活检证实的脑转移复发的治疗，LITT+SRT 优于单独 LITT 或重复 SRT。有必要进行前瞻性试验来验证 LITT+SRT 组合治疗复发性脑转移瘤的疗效。
Improved survival for patients with brain metastases has been accompanied by a rise in tumor recurrence after stereotactic radiotherapy (SRT). Laser interstitial thermal therapy (LITT) has emerged as an effective treatment for SRT failures as an alternative to open resection or repeat SRT. We aimed to evaluate the efficacy of LITT followed by SRT (LITT+SRT) in recurrent brain metastases. A multicenter, retrospective study was performed of patients who underwent treatment for biopsy-proven brain metastasis recurrence after SRT at an academic medical center. Patients were stratified by “planned LITT+SRT” versus “LITT alone” versus “repeat SRT alone.” Index lesion progression was determined by modified Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria. Fifty-five patients met inclusion criteria, with a median follow-up of 7.3 months (range: 1.0–30.5), age of 60 years (range: 37–86), Karnofsky Performance Status (KPS) of 80 (range: 60–100), and pre-LITT/biopsy contrast-enhancing volume of 5.7 cc (range: 0.7–19.4). Thirty-eight percent of patients underwent LITT+SRT, 45% LITT alone, and 16% SRT alone. Median time to index lesion progression (29.8, 7.5, and 3.7 months [P = .022]) was significantly improved with LITT+SRT. When controlling for age in a multivariate analysis, patients treated with LITT+SRT remained significantly less likely to have index lesion progression (P = .004). These data suggest that LITT+SRT is superior to LITT or repeat SRT alone for treatment of biopsy-proven brain metastasis recurrence after SRT failure. Prospective trials are warranted to validate the efficacy of using combination LITT+SRT for treatment of recurrent brain metastases.