目的:立体定向放射外科(SRS)通常适用于无法接受大型(>10cm3)脑转移瘤(BMs)手术切除的患者。阶段性SRS需要在照射期的每个阶段进行自适应规划,以改善肿瘤控制并减少辐射损伤。然而,目前还没有研究这种方法的肿瘤减少率。我们评估了多原发癌类型的两阶段SRS的结果。
方法:我们分析了178例最初接受两阶段SRS治疗的182例大型BM患者。原发性癌症包括乳腺癌(BC),非小细胞肺(NSCLC),和胃肠道癌症(GIC)。我们分析了总生存期(OS),神经死亡,全身性死亡(SD),肿瘤进展(TP),肿瘤复发(TR),放射性坏死(RN),以及两个阶段的肿瘤缩小率。
结果:首次伽玛刀手术(GKS)后的中位生存时间为6.6个月。与BC和NSCLC患者相比,GIC患者的OS较短,SD发生率较高.与NSCLC和GIC患者相比,在两个疗程中,BC患者的肿瘤减少率明显较高.原发性癌症类型的TP率相似。肿瘤减少率与肿瘤控制无关。RN的总累积发生率为4.2%;此外,原发癌类型的RN发生率相似.
结论:如果不需要手术切除,则应考虑对BC和NSCLC进行两阶段SRS。对于GIC的BM,分期SRS应仔细考虑,并适应每个独特的病例,因为其肿瘤减少率较低,OS较短.
OBJECTIVE: Stereotactic radiosurgery (SRS) is typically considered for patients who cannot undergo surgical resection for large (> 10 cm3) brain metastases (BMs). Staged SRS requires adaptive planning during each stage of the irradiation period for improved tumor control and reduced radiation damage. However, there has been no study on the tumor reduction rates of this method. We evaluated the outcomes of two-stage SRS across multiple primary cancer types.
METHODS: We analyzed 178 patients with 182 large BMs initially treated with two-stage SRS. The primary cancers included breast (BC), non-small cell lung (NSCLC), and gastrointestinal tract cancers (GIC). We analyzed the overall survival (OS), neurological death, systemic death (SD), tumor progression (TP), tumor recurrence (TR), radiation necrosis (RN), and the tumor reduction rate during both stages.
RESULTS: The median survival time after the first Gamma Knife surgery (GKS) procedure was 6.6 months. Compared with patients with BC and NSCLC, patients with GIC had shorter OS and a higher incidence of SD. Compared with patients with NSCLC and GIC, patients with BC had significantly higher tumor reduction rates in both sessions. TP rates were similar among primary cancer types. There was no association of the tumor reduction rate with tumor control. The overall cumulative incidence of RN was 4.2%; further, the RN rates were similar among primary cancer types.
CONCLUSIONS: Two-stage SRS should be considered for BC and NSCLC if surgical resection is not indicated. For BMs from GIC, staged SRS should be carefully considered and adapted to each unique case given its lower tumor reduction rate and shorter OS.