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Abstract：
OBJECTIVE: Intraoperative radiation therapy (IORT) is an emerging alternative to adjuvant stereotactic external beam radiation therapy (EBRT) following resection of brain metastases (BM). Advantages of IORT include an instant prevention of tumor regrowth, optimized dose-sparing of adjacent healthy brain tissue and immediate completion of BM treatment, allowing an earlier admission to subsequent systemic treatments. However, prospective outcome data are limited. We sought to assess long-term outcome of IORT in comparison to EBRT.
METHODS: A total of 35 consecutive patients, prospectively recruited within a study registry, who received IORT following BM resection at a single neuro-oncological center were evaluated for radiation necrosis (RN) incidence rates, local control rates (LCR), distant brain progression (DBP) and overall survival (OS) as long-term outcome parameters. The 1 year-estimated OS and survival rates were compared in a balanced comparative matched-pair analysis to those of our institutional database, encompassing 388 consecutive patients who underwent adjuvant EBRT after BM resection.
RESULTS: The median IORT dose was 30 Gy prescribed to the applicator surface. A 2.9% RN rate was observed. The estimated 1 year-LCR was 97.1% and the 1 year-DBP-free survival 73.5%. Median time to DBP was 6.4 (range 1.7-24) months in the subgroup of patients experiencing intracerebral progression. The median OS was 17.5 (0.5-not reached) months with a 1 year-survival rate of 61.3%, which did not not significantly differ from the comparative cohort (p = 0.55 and p = 0.82, respectively).
CONCLUSIONS: IORT is a safe and effective fast-track approach following BM resection, with comparable long-term outcomes as adjuvant EBRT.
METHODS: A total of 35 consecutive patients, prospectively recruited within a study registry, who received IORT following BM resection at a single neuro-oncological center were evaluated for radiation necrosis (RN) incidence rates, local control rates (LCR), distant brain progression (DBP) and overall survival (OS) as long-term outcome parameters. The 1 year-estimated OS and survival rates were compared in a balanced comparative matched-pair analysis to those of our institutional database, encompassing 388 consecutive patients who underwent adjuvant EBRT after BM resection.
RESULTS: The median IORT dose was 30 Gy prescribed to the applicator surface. A 2.9% RN rate was observed. The estimated 1 year-LCR was 97.1% and the 1 year-DBP-free survival 73.5%. Median time to DBP was 6.4 (range 1.7-24) months in the subgroup of patients experiencing intracerebral progression. The median OS was 17.5 (0.5-not reached) months with a 1 year-survival rate of 61.3%, which did not not significantly differ from the comparative cohort (p = 0.55 and p = 0.82, respectively).
CONCLUSIONS: IORT is a safe and effective fast-track approach following BM resection, with comparable long-term outcomes as adjuvant EBRT.
摘要：
目的：术中放射治疗（IORT）是脑转移瘤（BM）切除后的辅助立体定向外束放射治疗（EBRT）的新兴替代方案。IORT的优势包括即时预防肿瘤再生，优化邻近健康脑组织的剂量节约，并立即完成BM治疗，允许更早入院接受随后的系统治疗。然而,前瞻性结果数据有限。我们试图评估IORT与EBRT的长期结果。
方法：共有35名连续患者，在研究登记处前瞻性招募，在单个神经肿瘤中心接受BM切除后接受IORT的患者进行放射性坏死（RN）发生率评估，本地控制率（LCR），远端脑进展（DBP）和总生存期（OS）作为长期结局参数。在平衡比较配对分析中，将1年估计的OS和生存率与我们的机构数据库进行了比较，纳入了在BM切除术后接受辅助性EBRT的388例连续患者。
结果：给涂药器表面的IORT剂量中位数为30Gy。观察到2.9%的RN率。估计1年LCR为97.1%，1年无DBP生存率为73.5%。在经历脑内进展的患者亚组中，DBP的中位时间为6.4（范围1.7-24）个月。中位OS为17.5个月（未达到0.5个月），1年生存率为61.3％，与比较队列没有显着差异（分别为p=0.55和p=0.82）。
结论：IORT是BM切除后安全有效的快速途径，与辅助EBRT具有相当的长期结局。
方法：共有35名连续患者，在研究登记处前瞻性招募，在单个神经肿瘤中心接受BM切除后接受IORT的患者进行放射性坏死（RN）发生率评估，本地控制率（LCR），远端脑进展（DBP）和总生存期（OS）作为长期结局参数。在平衡比较配对分析中，将1年估计的OS和生存率与我们的机构数据库进行了比较，纳入了在BM切除术后接受辅助性EBRT的388例连续患者。
结果：给涂药器表面的IORT剂量中位数为30Gy。观察到2.9%的RN率。估计1年LCR为97.1%，1年无DBP生存率为73.5%。在经历脑内进展的患者亚组中，DBP的中位时间为6.4（范围1.7-24）个月。中位OS为17.5个月（未达到0.5个月），1年生存率为61.3％，与比较队列没有显着差异（分别为p=0.55和p=0.82）。
结论：IORT是BM切除后安全有效的快速途径，与辅助EBRT具有相当的长期结局。
