Relationship between pattern of enhancement and local control of brain metastases after radiosurgery
Relationship between pattern of enhancement and local control of brain metastases after radiosurgery
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DOI：
10.1016/s0360-3016(00)01584-4
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发表时间：
2001-05-01
影响因子：
7
通讯作者：
Larson, DA
中科院分区：
文献类型：
--
作者：
Goodman, KA;Sneed, PK;Larson, DA
目的：提高脑转移瘤的局部控制是放射外科治疗的一个理想目标。我们早期的回顾性研究发现，在219例脑转移瘤患者中，治疗日影像学增强模式可作为RS后无进展（FFP）的预后指标。目前的研究进行，以证实这一初步finding.Methods和材料：记录和影像学研究的患者治疗RS从1991年至1997年进行了审查。每个转移瘤被分类为均匀增强、不均匀增强或环形增强。计算从RS日期至首次成像显示肿瘤进展的Kaplan-Meier FFP。单变量和多变量分析采用考克斯比例风险模型分层的主要网站和类型的RS（单独，作为一个加强，或复发）。强化方式均匀者占59%，不均匀者占32%，环形者占8%。均匀增强、不均匀增强和环形增强病变的1年FFP概率分别为90%（95%置信区间，84-93%）、76%（64-84%）和57%（35-74%）。调整RS剂量和治疗期（1991-1994 vs. 1995-1997）的分层多变量分析的增强模式的p值为0.019，调整肿瘤体积而不是RS dose.Conclusion：增强模式被证实为RS治疗脑转移瘤FFP的一个重要预后因素，与剂量和体积无关。一个可能的解释是与坏死区域相关的缺氧肿瘤细胞的放射抗性，这表明未来的研究与放射增敏剂，缺氧细胞增敏剂，或改善肿瘤氧合的策略。(C)2001 Elsevier Science Inc.
Purpose: A desired goal in the radiosurgery (RS) of brain metastases is improved Local control. Our earlier retrospective review identified pattern of enhancement on day-of-treatment imaging as a prognostic indicator for freedom from progression (FFP) after RS in 219 brain metastases. The current study was performed to corroborate this preliminary finding.Methods and Materials: Records and imaging studies of patients treated with RS from 1991 to 1997 were reviewed. Each metastasis was categorized as homogeneously-, heterogeneously-, or ring-enhancing. Kaplan-Meier FFP was calculated from the date of RS to the first imaging showing tumor progression. Univariate and multivariate analyses were performed using Cox proportional hazard models stratified by primary site and type of RS (alone, as a boost, or for recurrence).Results: Of 682 lesions in 258 patients, 518 lesions in 193 patients were evaluable. Pattern of enhancement was homogeneous in 59%, heterogeneous in 32%, and ring-like in 8% of lesions. One-year FFP probabilities for homogeneously-, heterogeneously-, and ring-enhancing lesions were 90% (95% confidence interval, 84-93%), 76% (64-84%), and 57% (35-74%), respectively. The p-value for pattern of enhancement from the stratified multivariate analysis was 0.019 adjusting for RS dose and treatment period (1991-1994 vs. 1995-1997), Similar results were achieved adjusting for tumor volume instead of RS dose.Conclusion: Pattern of enhancement is confirmed as a significant prognostic factor for FFP of brain metastases treated with RS, independent of dose and volume. A possible explanation is radioresistance of hypoxic tumor cells associated with necrotic regions, suggesting future investigations with radiosensitizers, hypoxic cell sensitizers, or strategies to improve tumor oxygenation. (C) 2001 Elsevier Science Inc.