Tumor Control Probability of Radiosurgery and Fractionated Stereotactic Radiosurgery for Brain Metastases
Tumor Control Probability of Radiosurgery and Fractionated Stereotactic Radiosurgery for Brain Metastases
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DOI：
10.1016/j.ijrobp.2020.10.034
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发表时间：
2021-04-14
影响因子：
7
通讯作者：
Kleinberg, Lawrence R.
中科院分区：
文献类型：
--
作者：
Redmond, Kristin J.;Gui, Chengcheng;Kleinberg, Lawrence R.
目的：作为美国物理学家医学协会立体定向体部放射治疗工作组的一部分，根据已发表的英文文献中汇集的剂量学和临床数据，对脑转移瘤立体定向放射外科(SRS)和分次立体定向放射外科(FSRs)治疗后的肿瘤控制概率(TCP)进行建模。方法和材料：采用PubMed索引的研究方法，评价脑转移瘤立体定向放射外科(SRS)和分割立体定向放射外科(FSRs)治疗后的剂量学和临床预测因素。符合条件的研究有10名患者，包括详细的剂量分割数据和相应的一年局部对照(LC)数据，通常以SRS前直径为参考评估靶区直径增加20%。结果：在2951篇潜在符合条件的手稿中，56篇包含了足够的剂量-体积数据用于分析。接受坏死和假性进展可以使LC的评估复杂化，对于肿瘤，1年LC率分别为85%和95%。对于21到30 mm的肿瘤，18Gy单次剂量与75%的LC相关。对于31到40 mm的肿瘤，15Gy单次剂量与69%的LC相似。对于直径21~40 mm的肿瘤，采用27~35Gy3~5次剂量的FSR，1年内可获得80%的LC。对于20 mm的小病灶，局部控制率似乎接近70%至75%，通常剂量为15至18Gy，在这种情况下，应考虑FSRs方案。报告剂量学和LC数据需要更大的一致性，以促进未来的汇集分析。随着系统和生物疗法的发展，将需要更新的分析来进一步评估SRS和FSR的必要性、有效性和毒性。(C)2020 Elsevier Inc.保留所有权利。
Purpose: As part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy, tumor control probability (TCP) after stereotactic radiosurgery (SRS) and fractionated stereotactic radiosurgery (fSRS) for brain metastases was modeled based on pooled dosimetric and clinical data from published English-language literature.Methods and Materials: PubMed-indexed studies published between January 1995 and September 2017 were used to evaluate dosimetric and clinical predictors of TCP after SRS or fSRS for brain metastases. Eligible studies had >= 10 patients and included detailed dose-fractionation data with corresponding >= 1-year local control (LC) data, typically evaluated as a >20% increase in diameter of the targeted lesion using the pre-SRS diameter as a reference.Results: Of 2951 potentially eligible manuscripts, 56 included sufficient dose-volume data for analyses. Accepting that necrosis and pseudoprogression can complicate the assessment of LC, for tumors 85% and 95% 1-year LC rates, respectively. For tumors 21 to 30 mm, an 18 Gy single-fraction dose was associated with 75% LC. For tumors 31 to 40 mm, a 15 Gy single-fraction dose yielded similar to 69% LC. For 3-to 5-fraction fSRS using doses in the range of 27 to 35 Gy, 80% 1-year LC has been achieved for tumors of 21 to 40 mm in diameter.Conclusions: TCP for SRS and fSRS are presented. For small lesions 20 mm, local control rates appear to be approximate to 70% to 75% with usual doses of 15 to 18 Gy, and in this setting, fSRS regimens should be considered. Greater consistency in reporting of dosimetric and LC data is needed to facilitate future pooled analyses. As systemic and biologic therapies evolve, updated analyses will be needed to further assess the necessity, efficacy, and toxicity of SRS and fSRS. (C) 2020 Elsevier Inc. All rights reserved.