Abstract：
OBJECTIVE: The goal of this study was to characterize local tumor control (LC), overall survival (OS), and safety of stereotactic radiosurgery for colorectal brain metastasis (CRBM).
METHODS: Ten international institutions participating in the International Radiosurgery Research Foundation provided data for this retrospective case series. This study included 187 patients with CRBM (281 tumors), with a median age of 62 years and 56.7% being male. Most patients (53.5%) had solitary tumors, although 10.7% had > 5 tumors. The median tumor volume was 2.7 cm3 (IQR 0.22-8.1 cm3), and the median margin dose was 20 Gy (IQR 18-22 Gy).
RESULTS: The 3-year LC and OS rates were 72% and 20%, respectively. Symptomatic adverse radiation effects occurred in 1.6% of patients. In the multivariate analysis, age > 65 years and tumor volume > 4.0 cm3 were significant predictors of tumor progression (hazard ratio [HR] 2.6, 95% CI 1.4-4.9; p = 0.003 and HR 3.4, 95% CI 1.7-6.9; p < 0.001, respectively). Better performance status (Karnofsky Performance Scale score > 80) was associated with a reduced risk of tumor progression (HR 0.38, 95% CI 0.19-0.73; p = 0.004). Patient age > 62 years (HR 1.6, 95% CI 1.1-2.3; p = 0.03) and the presence of active extracranial disease (HR 1.7, 95% CI 1.1-2.4; p = 0.009) were significantly associated with worse OS.
CONCLUSIONS: Stereotactic radiosurgery offers a high LC rate and a low rate of symptomatic adverse radiation effects for the majority of CRBMs. The OS and LC favored younger patients with high functional performance scores and inactive extracranial disease.
METHODS: Ten international institutions participating in the International Radiosurgery Research Foundation provided data for this retrospective case series. This study included 187 patients with CRBM (281 tumors), with a median age of 62 years and 56.7% being male. Most patients (53.5%) had solitary tumors, although 10.7% had > 5 tumors. The median tumor volume was 2.7 cm3 (IQR 0.22-8.1 cm3), and the median margin dose was 20 Gy (IQR 18-22 Gy).
RESULTS: The 3-year LC and OS rates were 72% and 20%, respectively. Symptomatic adverse radiation effects occurred in 1.6% of patients. In the multivariate analysis, age > 65 years and tumor volume > 4.0 cm3 were significant predictors of tumor progression (hazard ratio [HR] 2.6, 95% CI 1.4-4.9; p = 0.003 and HR 3.4, 95% CI 1.7-6.9; p < 0.001, respectively). Better performance status (Karnofsky Performance Scale score > 80) was associated with a reduced risk of tumor progression (HR 0.38, 95% CI 0.19-0.73; p = 0.004). Patient age > 62 years (HR 1.6, 95% CI 1.1-2.3; p = 0.03) and the presence of active extracranial disease (HR 1.7, 95% CI 1.1-2.4; p = 0.009) were significantly associated with worse OS.
CONCLUSIONS: Stereotactic radiosurgery offers a high LC rate and a low rate of symptomatic adverse radiation effects for the majority of CRBMs. The OS and LC favored younger patients with high functional performance scores and inactive extracranial disease.
摘要：
目的：本研究的目的是表征局部肿瘤控制（LC），总生存期（OS），立体定向放射外科治疗结直肠脑转移（CRBM）的安全性。
方法：参与国际放射外科研究基金会的10个国际机构为这个回顾性病例系列提供了数据。这项研究包括187例CRBM患者（281例肿瘤），年龄中位数为62岁，男性占56.7%。大多数患者（53.5%）有孤立性肿瘤，尽管10.7％的肿瘤>5。中位肿瘤体积为2.7cm3（IQR0.22-8.1cm3），中位边缘剂量为20Gy（IQR18-22Gy）。
结果：3年LC和OS率分别为72%和20%，分别。1.6%的患者出现有症状的辐射不良反应。在多变量分析中，年龄>65岁和肿瘤体积>4.0cm3是肿瘤进展的显著预测因子(风险比[HR]2.6,95%CI1.4-4.9;p=0.003和HR3.4,95%CI1.7-6.9;p<0.001,分别).更好的性能状态（Karnofsky性能量表评分>80）与肿瘤进展风险降低相关（HR0.38，95％CI0.19-0.73；p=0.004）。患者年龄>62岁(HR1.6,95%CI1.1-2.3;p=0.03)和存在活动性颅外疾病(HR1.7,95%CI1.1-2.4;p=0.009)与不良OS显著相关。
结论：立体定向放射外科为大多数CRBM提供了较高的LC率和较低的症状性不良放射效应率。OS和LC有利于具有较高功能表现评分和非活动性颅外疾病的年轻患者。
方法：参与国际放射外科研究基金会的10个国际机构为这个回顾性病例系列提供了数据。这项研究包括187例CRBM患者（281例肿瘤），年龄中位数为62岁，男性占56.7%。大多数患者（53.5%）有孤立性肿瘤，尽管10.7％的肿瘤>5。中位肿瘤体积为2.7cm3（IQR0.22-8.1cm3），中位边缘剂量为20Gy（IQR18-22Gy）。
结果：3年LC和OS率分别为72%和20%，分别。1.6%的患者出现有症状的辐射不良反应。在多变量分析中，年龄>65岁和肿瘤体积>4.0cm3是肿瘤进展的显著预测因子(风险比[HR]2.6,95%CI1.4-4.9;p=0.003和HR3.4,95%CI1.7-6.9;p<0.001,分别).更好的性能状态（Karnofsky性能量表评分>80）与肿瘤进展风险降低相关（HR0.38，95％CI0.19-0.73；p=0.004）。患者年龄>62岁(HR1.6,95%CI1.1-2.3;p=0.03)和存在活动性颅外疾病(HR1.7,95%CI1.1-2.4;p=0.009)与不良OS显著相关。
结论：立体定向放射外科为大多数CRBM提供了较高的LC率和较低的症状性不良放射效应率。OS和LC有利于具有较高功能表现评分和非活动性颅外疾病的年轻患者。
