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首页> 外文期刊>Journal of neuro-oncology. >Clinical outcomes of patients treated with a second course of stereotactic radiosurgery for locally or regionally recurrent brain metastases after prior stereotactic radiosurgery
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Clinical outcomes of patients treated with a second course of stereotactic radiosurgery for locally or regionally recurrent brain metastases after prior stereotactic radiosurgery

机译：在先前立体定向放射外科术后局部或区域复发性脑转移的第二课时治疗患者的临床结果

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Patients with metastatic disease are living longer and may be confronted with locally or regionally recurrent brain metastases (BM) after prior stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). This study analyzes outcomes in patients without prior whole brain radiotherapy (WBRT) who were treated with a second course of SRS/FSRT for locally or regionally recurrent BM. We identified 32 patients at our institution who were treated with a second course of SRS/FSRT after initial SRS/FSRT for newly diagnosed BM. We report clinical outcomes including local control, survival, and toxicities. Control rates and survival were calculated using Kaplan-Meier analysis and the multivariate proportional hazards model. The Kaplan-Meier estimate of local control at 6 months was 77 % for targets treated by a second course of SRS/FSRT with 11/71 (15 %) targets experiencing local failure. Multivariate analysis shows that upon re-treatment, local recurrences were more likely to fail than regional recurrences (OR 8.8, p = 0.02). Median survival for all patients from first SRS/FSRT was 14.6 months (5.3-72.2 months) and 7.9 months (0.7-61.1 months) from second SRS/FSRT. Thirty-eight percent of patients ultimately received WBRT as salvage therapy after the second SRS/FSRT. Seventy-one percent of patients died without active neurologic symptoms. The present study demonstrates that the majority of patients who progress after SRS/FSRT for newly diagnosed BM are candidates for salvage SRS/FSRT. By reserving WBRT for later salvage, we believe that a significant proportion of patients can avoid WBRT all together, thus putting fewer patients at risk for neurocognitive toxicity.
机译：转移性疾病的患者寿命更长，并且可以在先前立体定向放射牢（SRS）或分级立体定向放射治疗（FSRT）之后局部或区域复发性脑转移（BM）。本研究分析了没有现有脑放射治疗（WBRT）的患者的结果，该脑放疗（WBRT）在局部或区域复发BM的第二课程中被一次SRS / FSRT治疗。我们在我们的机构确定了32名患者，他在初始SRS / FSRT后进行了第二级SRS / FSRT对新诊断的BM治疗。我们报告了临床结果，包括局部对照，生存和毒性。使用Kaplan-Meier分析和多变量比例危险模型计算控制率和生存率。通过11/71（15％）目标局部失败的每次SRS / FSRT治疗的目标，6个月的Kaplan-Meier对局部控制的估计为77％。多变量分析表明，在重新治疗后，局部复发比区域复发更可能失效（或8.8，P = 0.02）。来自第一次SRS / FSRT的所有患者的中位生存率为14.6个月（5.3-72.2个月）和7.9个月（0.7-61.1个月），来自第二个SRS / FSRT。三十八名患者最终收到了第二个SRS / FSRT后作为救助治疗的WBRT。百分之七十二患者死亡而没有活跃的神经系统症状。本研究表明，大多数患者在新诊断为新诊断的BM后进展的患者是Salvage SRS / FSRT的候选者。通过保留WBRT以供以后挽救，我们认为大量比例的患者可以避免均在一起，因此将较少的患者造成神经认知毒性的风险。

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