Staged Gamma Knife radiosurgery for large brain metastases: local control and the influence of systemic treatment

IF 5.3 1区 医学 Q1 ONCOLOGY
R.G. Huisman , P. van Schie , L.G. Merckel , T. Wiersma , J.L. Knegjens , E.P.M. Jansen , A. Compter , D. Brandsma , M. Bot , J. Hoogmoed , P.C. de Witt Hamer , G.R. Borst , R. Post
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Abstract

Background and purpose

Staged Gamma Knife radiosurgery (SGKRS) delivers high-dose radiotherapy to large brain metastases (BM) in two or three fractions with a time interval of several weeks. Various systemic treatments have also demonstrated favorable intracranial responses. Therefore, the outcome of patients undergoing radiosurgery and systemic treatment for large BM is of high interest but unknown.

Materials and methods

A retrospective cohort study was conducted on patients with large BM treated with SGKRS without previous local treatment directed to the brain. The primary outcome measure was the probability of intracranial local control at 12 months, calculated by the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were performed to identify variables associated with intracranial local control.

Results

295 patients were included. Intracranial local control probability at 12 months was 83 % and overall survival at 12 months was 39 %. In the multivariable Cox regression analysis, receiving any type of concurrent or adjuvant systemic treatment (adjusted hazard ratio [aHR] 0.30, 95 % confidence interval [CI] 0.15–0.61) and volume reduction between the first and second fraction (aHR 0.99, 95 % CI 0.98–0.998) were significantly associated with better intracranial local control. Larger total volume of all treated BM (aHR 1.02, 95 % CI 1.01–1.04) was significantly associated with worse intracranial local control. The probability of symptomatic cerebral radiation necrosis at 12 months was 26 %.

Conclusion

SGKRS results in high local control, with further improvement when systemic treatment is administered. However, overall survival remains limited, highlighting the importance of adequate patient selection.
分期伽玛刀放射治疗大面积脑转移:局部控制和全身治疗的影响。
背景和目的:分期伽玛刀放射外科(SGKRS)对大脑转移瘤(BM)分两段或三段进行高剂量放疗,间隔时间为几周。各种全身治疗也显示出良好的颅内反应。因此,患者接受放射手术和全身治疗的大BM的结果是高度关注但未知的。材料和方法:回顾性队列研究采用SGKRS治疗的大脑梗死患者,既往未进行过局部颅脑治疗。主要结局指标是在12 个月时颅内局部控制的概率,通过Kaplan-Meier方法计算。进行单因素和多因素Cox回归分析以确定与颅内局部控制相关的变量。结果:纳入295例患者。12 个月时颅内局部控制概率为83 %,12 个月时总生存率为39 %。在多变量Cox回归分析中,接受任何类型的同时或辅助全身治疗(校正风险比[aHR] 0.30, 95 %可信区间[CI] 0.15-0.61)和第一部分和第二部分之间的体积缩小(aHR 0.99, 95 % CI 0.98-0.998)与更好的颅内局部控制显著相关。所有治疗的BM总容积较大(aHR 1.02, 95 % CI 1.01-1.04)与颅内局部控制较差显著相关。12 个月时出现症状性脑放射性坏死的概率为26 %。结论:SGKRS的局部控制性较好,全身治疗后可进一步改善。然而,总体生存率仍然有限,这突出了充分选择患者的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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