Purpose: to evaluate an SRT approach in patients with at least 10 lesions at the time of BM initial diagnosis. Methods: This is a monocentric prospective cohort of patients treated by SRT, followed by a brain MRI every two months. Subsequent SRT could be delivered in cases of new BMs during follow-up. The main endpoints were local control rate (LCR), overall survival (OS), and strategy success rate (SSR). Acute and late toxicity were evaluated. Results: Seventy patients were included from October 2014 to January 2019, and the most frequent primary diagnosis was non-small-cell lung cancer (N = 36, 51.4%). A total of 1174 BMs were treated at first treatment, corresponding to a median number of 14 BMs per patient. Most of the patients (N = 51, 72.6%) received a single fraction of 20–24 Gy. At 1 year, OS was 62.3%, with a median OS of 19.2 months, and SSR was 77.8%. A cumulative number of 1537 BM were treated over time, corresponding to a median cumulative number of 16 BM per patient. At 1-year, the LCR was 97.3%, with a cumulative incidence of radio-necrosis of 2.1% per lesion. Three patients (4.3%) presented Grade 2 toxicity, and there was no Grade ≥ 3 toxicity. The number of treated BMs and the treatment volume did not influence OS or SSR (p> 0.05). Conclusions: SRT was highly efficient in controlling the BM, with minimal side effects. In this setting, an SRT treatment should be proposed even in patients with ≥10 BMs at diagnosis.
目的：评估在脑转移（BM）初诊时病灶数量≥10个的患者中采用立体定向放射治疗（SRT）的效果。方法：本研究为单中心前瞻性队列研究，纳入接受SRT治疗的患者，并每两个月进行一次脑部磁共振成像（MRI）随访。若随访期间出现新发脑转移灶，可再次进行SRT治疗。主要终点指标包括局部控制率（LCR）、总生存期（OS）和策略成功率（SSR），同时评估急性及晚期毒性反应。结果：2014年10月至2019年1月期间共纳入70例患者，最常见的原发诊断为非小细胞肺癌（N=36，51.4%）。首次治疗共处理1174个脑转移灶，中位病灶数为每例患者14个。大多数患者（N=51，72.6%）接受单次20–24 Gy剂量照射。1年OS为62.3%，中位OS为19.2个月，SSR为77.8%。随时间推移累计治疗1537个脑转移灶，每例患者中位累计病灶数为16个。1年LCR达97.3%，病灶放射性坏死累计发生率为2.1%。3例患者（4.3%）出现2级毒性反应，未发生≥3级毒性反应。治疗脑转移灶数量及治疗体积对OS或SSR均无显著影响（p>0.05）。结论：SRT在控制脑转移灶方面具有高效性，且副作用极小。在此背景下，即使初诊时脑转移灶数量≥10个的患者也应考虑采用SRT治疗。
肿瘤(癌症)患者之家