文章：

大体积脑转移瘤的分次立体定向调强放疗：放射性脑坏死的剂量-体积预测因子综合分析

Fractionated Stereotactic Intensity-Modulated Radiotherapy for Large Brain Metastases: Comprehensive Analyses of Dose–Volume Predictors of Radiation-Induced Brain Necrosis

原文发布日期：28 September 2024

DOI: 10.3390/cancers16193327

类型: Article

开放获取: 是

英文摘要：

Background: The objective was to explore dosimetric predictors of brain necrosis (BN) in fractionated stereotactic radiotherapy (SRT). Methods: After excluding collinearities carefully, multivariate logistic models were developed for comprehensive analyses of dosimetric predictors in patients who received first-line fractionated SRT for brain metastases (BMs). The normal brain volume receiving an xx Gy biological dose in 2 Gy fractions (VxxEQD2) was calculated from the retrieved dose–volume parameters. Results: Thirty Gy/3 fractions (fr) SRT was delivered to 34 patients with 75 BMs (median target volume, 3.2 cc), 35 Gy/5 fr to 30 patients with 57 BMs (6.4 cc), 37.5 Gy/5 fr to 28 patients with 47 BMs (20.2 cc), and 40 Gy/10 fr to 20 patients with 37 BMs (24.3 cc), according to protocols, depending on the total target volume (p< 0.001). After excluding the three-fraction groups, the incidence of symptomatic BN was significantly higher in patients with a larger V50EQD2 (adjusted odds ratio: 1.07,p< 0.02), V55EQD2 (1.08,p< 0.01), or V60EQD2 (1.09,p< 0.01) in the remaining five- and ten-fraction groups. The incidence of BN was also significantly higher in cases with V55EQD2 > 30 cc or V60EQD2 > 20 cc (p< 0.05). These doses correspond to 28 or 30 Gy/5 fr and 37 or 40 Gy/10 fr, respectively. Conclusions: In five- or ten-fraction SRT, larger V55EQD2 or V60EQD2 are BN risk predictors. These biologically high doses may affect BN incidence. Thus, the planning target volume margin should be minimized as much as possible.

摘要翻译： 

背景：本研究旨在探讨分次立体定向放疗（SRT）中脑坏死（BN）的剂量学预测因子。方法：在仔细排除共线性后，针对接受一线分次SRT治疗的脑转移瘤（BMs）患者，建立多变量逻辑回归模型以综合分析剂量学预测因子。根据提取的剂量-体积参数，计算了正常脑组织在2 Gy分次照射下接受xx Gy生物剂量（VxxEQD2）的体积。结果：根据治疗方案，依据总靶体积（p<0.001），对34例患者（75个BMs，中位靶体积3.2 cc）实施30 Gy/3次（fr）SRT，对30例患者（57个BMs，6.4 cc）实施35 Gy/5 fr，对28例患者（47个BMs，20.2 cc）实施37.5 Gy/5 fr，对20例患者（37个BMs，24.3 cc）实施40 Gy/10 fr。排除三分割组后，在剩余的五分割和十分割组中，V50EQD2（校正比值比：1.07，p<0.02）、V55EQD2（1.08，p<0.01）或V60EQD2（1.09，p<0.01）值较大的患者，其症状性BN发生率显著更高。当V55EQD2 > 30 cc或V60EQD2 > 20 cc时，BN发生率也显著升高（p<0.05）。这些剂量分别对应于28或30 Gy/5 fr以及37或40 Gy/10 fr。结论：在五分割或十分割SRT中，较大的V55EQD2或V60EQD2是BN的风险预测因子。这些生物学高剂量可能影响BN的发生率。因此，应尽可能缩小计划靶区外放边界。

原文链接：

Fractionated Stereotactic Intensity-Modulated Radiotherapy for Large Brain Metastases: Comprehensive Analyses of Dose–Volume Predictors of Radiation-Induced Brain Necrosis