Proton Stereotactic Radiosurgery for Brain Metastases: A Single-Institution Analysis of 370 Patients
Proton Stereotactic Radiosurgery for Brain Metastases: A Single-Institution Analysis of 370 Patients
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DOI：
10.1016/j.ijrobp.2018.03.056
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发表时间：
2018-07-15
影响因子：
7
通讯作者：
Shih, Helen A.
中科院分区：
文献类型：
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作者：
Atkins, Katelyn M.;Pashtan, Itai M.;Shih, Helen A.
目的：报道质子立体定向放射手术（SRS）治疗单个或多个脑转移患者的第一个系列，包括失败模式、生存结果和毒性分析。方法和材料：这是一项单机构回顾性研究，纳入了1991年4月至2016年11月期间接受质子SRS治疗的370例患者的815例转移灶。计算局部衰竭、远端脑衰竭和病理证实的放射性坏死的累积发生率估计值和Kaplan-Meier估计的总生存率。采用Fine、Gray和Cox回归来确定临床和治疗因素是否与所描述的终点相关。结果：质子SRS的中位随访时间为9.2个月。6个月和12个月的局部衰竭、远端脑衰竭和总生存率分别为4.3%（95%可信区间[CI] 3.0%-5.9%）和8.5% (95% CI 6.7%-10.6%), 39.1% （95% CI 34.1%-44.0%）和48.2% (95% CI 43.0%-53.2%), 76.0% （95% CI 71.3%-80.0%）和51.5% （95% CI 46.3%-56.5%）。质子SRS后的中位生存期为12.4个月（95% CI 10.8-14.0个月）。最常见的症状是轻度疲劳（12.5%）、头痛（10.0%）、运动无力（6.2%）、癫痫发作（5.8%）和头晕（5.4%）。12个月病理证实的放射性坏死率为3.6% (95% CI 2.0%-5.8%)，多变量分析仅与靶体积相关（亚分布风险比1.13,95% CI 1.0-1.20）。结论：据我们所知，这是首次报道的一系列质子SRS治疗脑转移。与传统的光子SRS策略相比，中等剂量的质子SRS具有良好的耐受性，并且可以获得良好的局部控制结果。虽然质子SRS仍然是资源密集型的，未来的策略评估其选择性效用的患者谁将从整体剂量减少中获益最多应该探索。(C) 2018爱思唯尔公司版权所有。
Purpose: To report the first series of proton stereotactic radiosurgery (SRS) for the treatment of patients with single or multiple brain metastases, including failure patterns, survival outcomes, and toxicity analysis.Methods and Materials: This was a single-institution, retrospective study of 815 metastases from 370 patients treated with proton SRS between April 1991 and November 2016. Cumulative incidence estimates of local failure, distant brain failure, and pathologically confirmed radionecrosis and Kaplan-Meier estimates of overall survival were calculated. Fine and Gray and Cox regressions were performed to ascertain whether clinical and treatment factors were associated with the described endpoints.Results: The median follow-up from proton SRS was 9.2 months. The 6- and 12month estimates of local failure, distant brain failure, and overall survival were 4.3% (95% confidence interval [CI] 3.0%-5.9%) and 8.5% (95% CI 6.7%-10.6%), 39.1% (95% CI 34.1%-44.0%) and 48.2% (95% CI 43.0%-53.2%), and 76.0% (95% CI 71.3%-80.0%) and 51.5% (95% CI 46.3%-56.5%), respectively. The median survival was 12.4 months (95% CI 10.8-14.0 months) after proton SRS. The most common symptoms were low-grade fatigue (12.5%), headache (10.0%), motor weakness (6.2%), seizure (5.8%), and dizziness (5.4%). The rate of pathologically confirmed radionecrosis at 12 months was 3.6% (95% CI 2.0%-5.8%), and only target volume was associated on multivariate analysis (subdistribution hazard ratio 1.13, 95% CI 1.0-1.20).Conclusions: To the best of our knowledge, this is the first reported series of proton SRS for the management of brain metastases. Moderate-dose proton SRS is well tolerated and can achieve good local control outcomes, comparable to those obtained with conventional photon SRS strategies. Although proton SRS remains resource-intensive, future strategies evaluating its selective utility in patients who would benefit most from integral dose reduction should be explored. (C) 2018 Elsevier Inc. All rights reserved.