Adjuvant Whole-Brain Radiotherapy Versus Observation After Radiosurgery or Surgical Resection of One to Three Cerebral Metastases: Results of the EORTC 22952-26001 Study
Adjuvant Whole-Brain Radiotherapy Versus Observation After Radiosurgery or Surgical Resection of One to Three Cerebral Metastases: Results of the EORTC 22952-26001 Study
复制标题
DOI：
10.1200/jco.2010.30.1655
复制
发表时间：
2011-01-10
影响因子：
45.3
通讯作者：
Mueller, Rolf-Peter
中科院分区：
文献类型：
--
作者：
Kocher, Martin;Soffietti, Riccardo;Mueller, Rolf-Peter
目的：欧洲癌症研究和治疗组织III期试验评估辅助全脑放疗（WBRT）是否增加脑转移手术或放疗后功能独立的持续时间。患者和方法伴有1 - 3个脑转移的实体瘤（小细胞肺癌除外），伴有稳定的全身性疾病或无症状的原发肿瘤，WHO性能状态（PS）为0 - 2，采用完全手术或放射手术治疗，并随机分配到辅助WBRT （30 Gy分10次）或观察组（OBS）。主要终点是WHO PS恶化至2以上的时间。结果359例患者中，199例行放射治疗，160例行手术治疗。放外科组100例患者接受OBS治疗，99例患者接受WBRT治疗。术后79例患者被分配到OBS组，81例患者被分配到辅助WBRT组。OBS后到WHO PS超过2个月的中位时间为10.0个月（95% CI, 8.1 - 11.7个月），WBRT后为9.5个月（95% CI, 7.8 - 11.9个月）（P = 0.71）。WBRT组和OBS组的总生存期相似（中位数分别为10.9个月和10.7个月；P = 0.89）。WBRT降低了初始部位（手术：59%至27%，P = 0.001；放射手术：31%至19%，P = 0.040）和新部位（手术：42%至23%，P = 0.008；放射手术：48%至33%，P = 0.023）的2年复发率。OBS后抢救疗法的使用频率高于WBRT后。颅内进展导致179例OBS组患者中78例（44%）死亡，180例WBRT组患者中50例（28%）死亡。结论放疗或部分脑转移瘤手术后，辅助WBRT可减少颅内复发和神经系统死亡，但不能改善功能独立时间和总生存期。[J]中华医学杂志，29(3):391 - 391。(C) 2010年由美国临床肿瘤学会出版
PurposeThis European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases.Patients and MethodsPatients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2.ResultsOf 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95% CI, 8.1 to 11.7 months) after OBS and 9.5 months (95% CI, 7.8 to 11.9 months) after WBRT (P = .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P = .001; radiosurgery: 31% to 19%, P = .040) and at new sites (surgery: 42% to 23%, P = .008; radiosurgery: 48% to 33%, P = .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm.ConclusionAfter radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival. J Clin Oncol 29:134-141. (C) 2010 by American Society of Clinical Oncology