A Phase 2 Trial of Stereotactic Radiosurgery Boost After Surgical Resection for Brain Metastases
A Phase 2 Trial of Stereotactic Radiosurgery Boost After Surgical Resection for Brain Metastases
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DOI：
10.1016/j.ijrobp.2013.09.051
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发表时间：
2014-01-01
影响因子：
7
通讯作者：
Beal, Kathryn
中科院分区：
文献类型：
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作者：
Brennan, Cameron;Yang, T. Jonathan;Beal, Kathryn
目的：探讨脑转移瘤手术切除及术后立体定向放射治疗（SRS）的局部控制效果。方法和材料：共有49例患者（50个病变）入选并可供分析。合格标准包括组织学证实的恶性肿瘤伴1或2个脑实质内转移，年龄>= 18岁，Karnofsky性能状态(KPS) >= 70。采用Cox比例风险回归模型检验临床因素与总生存期（OS）之间的显著相关性。使用Fine and Gray方法拟合竞争风险回归模型以及累积发生率函数，以评估临床因素与局部失败（LF；手术腔内或SRS靶点内复发）和区域失败（RF；治疗体积外颅内转移）之间的关系。结果：中位随访时间为12.0个月（范围1.0-94.1个月）。手术切除后，39例有40个病变的患者接受了中位31天（范围7-56天）的SRS治疗，中位剂量为1800 cGy（范围1500-2200 cGy）。在50个病变中，15个（30%）术后表现为LF。12个月时的累计LF和RF率分别为22%和44%。继续接受SRS治疗的患者LF发病率显著降低（P = 0.008）。与局部控制改善相关的其他因素包括非小细胞肺癌组织学（P = 0.048），肿瘤直径= 3cm)，浅表性硬脑膜/脑脊膜受损伤显示LF的风险最高（12个月时为53.3%）。SRS治疗的大浅表病变有54.5%的LF。与幕上病变相比，幕下病变发生RF的风险更高(P
Purpose: To evaluate local control after surgical resection and postoperative stereotactic radiosurgery (SRS) for brain metastases.Methods and Materials: A total of 49 patients (50 lesions) were enrolled and available for analysis. Eligibility criteria included histologically confirmed malignancy with 1 or 2 intraparenchymal brain metastases, age >= 18 years, and Karnofsky performance status (KPS) >= 70. A Cox proportional hazard regression model was used to test for significant associations between clinical factors and overall survival (OS). Competing risks regression models, as well as cumulative incidence functions, were fit using the method of Fine and Gray to assess the association between clinical factors and both local failure (LF; recurrence within surgical cavity or SRS target), and regional failure (RF; intracranial metastasis outside of treated volume).Results: The median follow-up was 12.0 months (range, 1.0-94.1 months). After surgical resection, 39 patients with 40 lesions were treated a median of 31 days (range, 7-56 days) later with SRS to the surgical bed to a median dose of 1800 cGy (range, 1500-2200 cGy). Of the 50 lesions, 15 (30%) demonstrated LF after surgery. The cumulative LF and RF rates were 22% and 44% at 12 months. Patients who went on to receive SRS had a significantly lower incidence of LF (P =.008). Other factors associated with improved local control include non-small cell lung cancer histology (P = .048), tumor diameter = 3 cm) with superficial dural/pial involvement showed the highest risk for LF (53.3% at 12 months). Large superficial lesions treated with SRS had a 54.5% LF. Infratentorial lesions were associated with a higher risk of developing RF compared to supratentorial lesions (P