个性化超分割立体定向自适应放疗(PULSAR)与中枢神经系统活性药物在脑转移瘤治疗中的探索性评估。

IF 6.4 1区 医学 Q1 ONCOLOGY
Michael Dohopolski, Luiza Giuliani Schmitt, Soummitra Anand, Haozhao Zhang, Strahinja Stojadinovic, Michael Youssef, Nawal Shaikh, Toral Patel, Ankur Patel, Sam Barnett, Dong Soo Lee, Chul Ahn, MinJae Lee, Robert Timmerman, Hao Peng, Xin Cai, Tu Dan, Zabi Wardak
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引用次数: 0

摘要

简介:脑转移瘤(BMs)影响着越来越多的癌症患者,通常采用立体定向放射外科手术(SRS)进行治疗。我院提倡使用个性化超分次立体定向自适应放疗(PULSAR),在这种疗法中,放射线以大剂量脉冲的方式在较长的时间间隔内发射,从而使治疗适应性更强,并易于同时进行全身治疗。我们探讨了 PULSAR 与中枢神经系统(CNS)活性药物(CNS-aDs)的整合:本研究对2018-2024年使用伽玛刀接受PULSAR治疗的患者进行了回顾性评估。我们收集了人口统计学、临床和具体治疗细节,以及局部失败(LF)和毒性率等结果。考虑到死亡是竞争风险,我们对局部失败和毒性进行了累积发生率分析,并对总生存率(OS)进行了卡普兰-梅耶生存分析:分析包括109个接受PULSAR治疗的病灶,主要是肺癌和乳腺癌患者。中位随访时间为 1.72 天。未达到中位生存期。1年和2年的LF率分别为5%和8.9%,并发CNS-aDs(cCNS-aDs)的LF率分别为3.4%和5.5%。大于 2 厘米的 BM 在两年内的低频率为 9.4%。采用PULSAR+CNS-aDs联合方法治疗2.5年后,在大于2厘米的肿瘤中未观察到LF。单变量分析表明,CNS-aD和放射反应性组织学与LR率下降有关。PULSAR的两年3级以上毒性率为8.7%,CNS-aDs的毒性没有增加:结论:PULSAR与CNS-aDs的整合似乎能为较大的脑转移瘤提供出色的局部控制,且毒性有限。这些令人鼓舞的结果值得进一步进行前瞻性研究,以验证研究结果,并有可能制定新的治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploratory Evaluation of Personalized Ultrafractionated Stereotactic Adaptive Radiation Therapy (PULSAR) With Central Nervous System-Active Drugs in Brain Metastases Treatment.

Purpose: Brain metastases (BMs) affect an increasing number of cancer patients and are typically managed with stereotactic radiosurgery (SRS). Our institution advocates the use of Personalized Ultrafractionated Stereotactic Adaptive Radiation Therapy (PULSAR), where radiation is delivered in high-dose pulses at extended intervals allowing for treatment adaptation and easy concurrent systemic therapy integration. We explore the integration of PULSAR with central nervous system (CNS)-active drugs (CNS-aDs).

Methods and materials: This study involved a retrospective evaluation of patients treated with PULSAR using Gamma Knife from 2018 to 2024. We collected demographic, clinical, and specific treatment details, as well as outcomes such as local failure (LF) and toxicity rates. Cumulative incidence analysis for LF and toxicity, considering death a competing risk, and Kaplan-Meier survival analysis for overall survival (OS) were conducted.

Results: Analysis included 109 lesions treated with PULSAR, predominantly in patients with lung and breast cancer. The median follow-up was 1.72. The median OS was not reached. The 1- and 2-year LF rates were 5% and 8.9%, respectively, and 3.4% and 5.5% with concurrent CNS-aDs (cCNS-aDs). BMs >2 cm had LF rates of 9.4% at 2 years. No LFs were observed in BMs >2 cm treated with the combined PULSAR+CNS-aDs approach at 2.5 years. Univariate analysis indicated CNS-aD and radioresponsive histologies were associated with decreased LF rates. The 2-year grade 3+ toxicity rate for PULSAR was 8.7%, with no increase in toxicity with cCNS-aDs.

Conclusions: The integration of PULSAR with CNS-aDs appears to offer excellent local control for larger BMs with limited toxicity. These promising results merit further prospective investigation to validate the findings and potentially establish new treatment protocols.

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来源期刊
CiteScore
11.00
自引率
7.10%
发文量
2538
审稿时长
6.6 weeks
期刊介绍: International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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