Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis.
Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis.
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DOI：
10.1186/1748-717x-6-48
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发表时间：
2011-05-15
期刊：
影响因子：
--
通讯作者：
Enrici RM
中科院分区：
文献类型：
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作者：
Minniti G;Clarke E;Lanzetta G;Osti MF;Trasimeni G;Bozzao A;Romano A;Enrici RM
研究影响接受立体定向放射外科 (SRS) 治疗的患者生存和毒性的因素，特别关注接受特定剂量 (V10 - V16 Gy) 的脑体积作为脑放射性坏死的预测因子。罗马大学 La Sapienza Sant'Andrea 医院连续 206 名患有 310 个小于 3.5 cm 脑转移瘤的患者接受了 SRS 作为主要治疗，并进行了前瞻性随访。使用从 SRS 时间计算的 Kaplan-Meier 方法估计总生存率、大脑控制和局部控制。使用 Cox 比例风险回归模型进行单变量和多变量分析，以确定治疗结果和 SRS 相关并发症的预后因素的预测价值。中位总生存期和大脑控制期分别为 14.1 个月和 10 个月。 1年和2年生存率分别为58%和24%，脑控制率分别为43%和22%。 SRS术后局部复发16例，1年和2年局部控制率分别为92%和84%。多变量分析显示，稳定的颅外疾病和 KPS > 70 与最显着的生存获益相关。 27 名 (13%) 患者出现神经系统并发症。 5.8% 的患者出现严重神经并发症（RTOG 3 级和 4 级）。 24% 的治疗病变发生脑放射性坏死，10% 有症状，14% 无症状。在多变量分析中，V10 至 V16 Gy 是放射性坏死的独立危险因素，其中 V10 Gy 和 V12 Gy 最具预测性（p = 0.0001）。对于 V10 Gy >12.6 cm3 和 V12 Gy >10.9 cm3，放射性坏死的风险为 47%。单独的放射外科治疗是脑转移患者初始治疗的一种可行选择，但很大一部分患者可能会出现神经系统并发症。 V12 Gy > 8.5 cm3 的病变具有 > 10% 的放射性坏死风险，应考虑进行大分割立体定向放射治疗，尤其是位于/靠近功能区时。
to investigate the factors affecting survival and toxicity in patients treated with stereotactic radiosurgery (SRS), with special attention to volumes of brain receiving a specific dose (V10 - V16 Gy) as predictors for brain radionecrosis. Two hundred six consecutive patients with 310 cerebral metastases less than 3.5 cm were treated with SRS as primary treatment and followed prospectively at University of Rome La Sapienza Sant'Andrea Hospital. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS. Univariate and multivariate analysis using a Cox proportional hazards regression model were performed to determine the predictive value of prognostic factors for treatment outcome and SRS-related complications. Median overall survival and brain control were 14.1 months and 10 months, respectively. The 1-year and 2-year survival rates were 58% and 24%, and respective brain control were 43% and 22%. Sixteen patients recurred locally after SRS, with 1-year and 2-year local control rates of 92% and 84%, respectively. On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit. Neurological complications were recorded in 27 (13%) patients. Severe neurological complications (RTOG Grade 3 and 4) occurred in 5.8% of patients. Brain radionecrosis occurred in 24% of treated lesions, being symptomatic in 10% and asymptomatic in 14%. On multivariate analysis, V10 through V16 Gy were independent risk factors for radionecrosis, with V10 Gy and V12 Gy being the most predictive (p = 0.0001). For V10 Gy >12.6 cm3 and V12 Gy >10.9 cm3 the risk of radionecrosis was 47%. SRS alone represents a feasible option as initial treatment for patients with brain metastases, however a significant subset of patients may develop neurological complications. Lesions with V12 Gy >8.5 cm3 carries a risk of radionecrosis >10% and should be considered for hypofractionated stereotactic radiotherapy especially when located in/near eloquent areas.