Stereotactic radiosurgery and fractionated stereotactic radiotherapy: comparison of efficacy and toxicity in 260 patients with brain metastases
Stereotactic radiosurgery and fractionated stereotactic radiotherapy: comparison of efficacy and toxicity in 260 patients with brain metastases
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DOI：
10.1007/s11060-012-0868-6
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发表时间：
2012-08-01
影响因子：
3.9
通讯作者：
Engenhart-Cabillic, Rita
中科院分区：
文献类型：
--
作者：
Fokas, Emmanouil;Henzel, Martin;Engenhart-Cabillic, Rita
我们回顾性评价并比较了立体定向放射外科（SRS）和分次立体定向放射治疗（FSRT）治疗脑转移瘤（BM）患者的疗效和毒性。2000年至2009年，260例1-3 BM患者使用SRS（中位剂量20戈伊; n = 138）或两种不同的FSRT剂量概念：7 x 5戈伊（n = 61）或10 x 4戈伊（n = 61）进行治疗。SRS、7 x 5戈伊和10 x 4戈伊的中位生存期分别为8、7和10个月（p = 0.575），总生存期（OS）为9个月。260例患者中有214例获得了随访成像数据。1年局部无进展生存期（LPFS）分别为73%、75%和71%（p = 0.191）。平均随访28个月（范围：2.1-77个月）后，完全缓解、部分缓解、疾病稳定和疾病进展率分别为29%、40%、21%和10%。在多变量分析中，RPA I级与更好的OS和区域无进展生存率相关（均p < 0.001）。与7 x 5戈伊和10 x 4戈伊组相比，SRS与更高的毒性率（I-III级）相关（分别为14 vs. 6 vs. 2%; p = 0.01）。尽管FSRT用于大病变和/或关键结构附近的病变，但LPFS与SRS相当。重要的是，FSRT表现出低毒性，并且似乎是不适合SRS的BM的有效且安全的治疗。10 x 4戈伊分次方案由于其疗效和安全毒性特征而值得进一步研究。
We retrospectively evaluated and compared the efficacy and the toxicity profile of stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for the treatment of patients with brain metastases (BM). Between 2000 and 2009, 260 patients with 1-3 BM were treated using either SRS (median dose 20 Gy; n = 138) or two different FSRT dose concepts: 7 x 5 Gy (n = 61) or 10 x 4 Gy (n = 61). The median survival for SRS, 7 x 5 Gy and 10 x 4 Gy was 8, 7 and 10 months (p = 0.575), respectively, and the overall survival (OS) was 9 months. Follow-up imaging data were available in 214 of the 260 patients. The 1-year local progression-free survival (LPFS) was 73, 75 and 71 %, respectively (p = 0.191). After a mean follow-up of 28 months (range: 2.1-77 months), the rate of complete remission, partial remission, stable disease and progressive disease were 29, 40, 21 and 10 %, respectively. On multivariate analysis, RPA class I was associated with better OS and regional progression-free survival (both p < 0.001). SRS was associated with a higher toxicity rate (grade I-III) compared to the 7 x 5 Gy and 10 x 4 Gy groups (14 vs. 6 vs. 2 %, respectively; p = 0.01). Although FSRT was used for large lesions and/or lesions near critical structures, the LPFS was comparable to SRS. Importantly, FSRT presented low toxicity and appears to be an effective and safe treatment for BM not amenable to SRS. The 10 x 4 Gy fractionation scheme warrants further investigation due to its efficacy and safe toxicity profile.