Background: The main advantages of stereotactic radiotherapy (SRT) are to delay whole-brain radiotherapy (WBRT) and to deliver ablative doses. Despite this efficacy, the risk of distant brain metastases (BM) one year after SRT ranges from 26% to 77% and 20 to 40% of patients required salvage treatment. The role and consequences of reirradiation remain unclear, particularly in terms of survival. The objective was to study overall survival (OS) and neurological death-free survival (NDFS) and to specify the prognostic factors of long-term survival. Methods: we retrospectively reviewed the data of patients treated between 2010 and 2020 with at least two courses of SRT without previous WBRT. Results: In total, 184 patients were treated for 915 BMs with two-to-six SRT sessions. Additional SRT sessions were provided for local (5.6%) or distant (94.4%) BM recurrence. The median number of BMs treated per SRT was one with a median of four BMs in total. The mean time between the two SRT sessions was 8.9 months (95%CI 7.7–10.1) and there was no significant difference in the delay between the two sessions. The 6-, 12- and 24-month NDFS rates were 97%, 82% and 52%, respectively. The 6-, 12- and 24-month OS rates were 91%, 70% and 38%, respectively. OS was statistically related to the number of SRT sessions (HR = 0.48;p< 0.01), recursive partitioning analysis (HR = 1.84;p= 0.01), salvage WBRT (HR = 0.48;p= 0.01) and brain metastasis velocity (high: HR = 13.83;p< 0.01; intermediate: HR = 4.93;p< 0.01). Conclusions: Lung cancer and melanoma were associated with a lower NDFS compared to breast cancer. A low KPS, a low number of SRT sessions, synchronous extracerebral metastases, synchronous BMs, extracerebral progression at SRT1, a high BMV grade, no WBRT and local recurrence were also associated with a lower NDFS. A high KPS at SRT1 and low BMV grade are prognostic factors for better OS, regardless of the number of BM recurrence events.
背景：立体定向放射治疗（SRT）的主要优势在于能够推迟全脑放疗（WBRT）并实施消融剂量照射。尽管疗效显著，但SRT治疗后一年内发生远处脑转移（BM）的风险仍介于26%至77%之间，且有20%至40%的患者需要接受挽救性治疗。再程放疗的作用及预后影响尚不明确，尤其在生存获益方面。本研究旨在分析总生存期（OS）与无神经功能缺损生存期（NDFS），并明确长期生存的预后因素。 方法：回顾性分析2010年至2020年间接受至少两次SRT疗程（既往未行WBRT）患者的临床资料。 结果：共纳入184例患者，累计治疗915处脑转移灶，接受2-6次SRT治疗。追加SRT疗程的原因包括局部复发（5.6%）或远处新发脑转移（94.4%）。单次SRT治疗中位病灶数为1个，累计治疗中位病灶数为4个。两次SRT疗程的平均间隔时间为8.9个月（95%CI 7.7-10.1），疗程间间隔时间无显著差异。6、12、24个月NDFS率分别为97%、82%、52%；同期OS率分别为91%、70%、38%。OS与SRT治疗次数（HR=0.48；p<0.01）、递归分区分析分级（HR=1.84；p=0.01）、挽救性WBRT（HR=0.48；p=0.01）及脑转移速率（高级别：HR=13.83；p<0.01；中级别：HR=4.93；p<0.01）存在统计学关联。 结论：与乳腺癌相比，肺癌和黑色素瘤患者的NDFS较低。低KPS评分、较少SRT治疗次数、同时性颅外转移、同时性脑转移、首次SRT时存在颅外进展、高级别脑转移速率、未行WBRT及局部复发均与较低NDFS相关。无论脑转移复发事件次数如何，首次SRT时高KPS评分和低级别脑转移速率均是改善OS的预后因素。
肿瘤(癌症)患者之家