Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis. 局部控制和存活结果，食管原发性脑转移的立体定向放射治疗：一项国际多中心分析。
Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis.
发表日期：2023 Mar 21
作者：
Raj Singh, Greg Bowden, David Mathieu, Haley K Perlow, Joshua D Palmer, Shahed Elhamdani, Matthew Shepard, Yun Liang, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdelkarim, Amr M N El-Shehaby, Reem M Emad, Ahmed Hesham Elazzazi, Ronald E Warnick, Yair M Gozal, Megan Daly, Brendan McShane, Marcel Addis-Jackson, Gokul Karthikeyan, Sian Smith, Piero Picozzi, Andrea Franzini, Tehila Kaisman-Elbaz, Huai-Che Yang, Zhishuo Wei, Andrew Legarreta, Judith Hess, Kelsey Templeton, Stylianos Pikis, Georgios Mantziaris, Gabriela Simonova, Roman Liscak, Selcuk Peker, Yavuz Samanci, Veronica Chiang, Ajay Niranjan, Charles R Kersh, Cheng-Chia Lee, Daniel M Trifiletti, L Dade Lunsford, Jason P Sheehan
来源：
NEUROSURGERY
摘要：
对于胃肠道（GI）原发性和脑转移病人采用立体定向放射外科（SRS）治疗的结果数据非常有限。本研究旨在分析GI原发性脑转移病人经过SRS治疗的临床结果，并评估潜在的预后因素。国际放射外科研究基金会调查了接受SRS治疗的GI原发性脑转移病人。主要结果指标是局部控制（LC）和总生存率（OS）。采用Kaplan-Meier分析进行单因素分析（UVA）来评估预后因素。显著的UVA因素使用Cox比例风险模型进行多因素分析。使用逻辑回归分析相关因素与RN的相关性。
我们确定了263名符合条件的病人，共543个脑转移灶。常见的原发部位是直肠（31.2％）、结肠（31.2％）和食道（25.5％），中位年龄为61.6岁（范围：37-91.4岁），中位Karnofsky表现状态（KPS）为90％（范围：40％-100％）。一年和两年的LC率分别为83.5％（95％CI：78.9％-87.1％）和73.0％（95％CI：66.4％-78.5％）。在单因素分析中，年龄>65岁（P = .001），单次剂量<20 Gy（P = .006），KPS＜90％（P＜.001）和计划靶体积≥2cc（P = .007）与LC差异显著相关。除剂量外的所有因素，在多因素分析中也均表现出显著性（P≤.002）。一年和两年的OS率分别为68.0％（95％CI：61.5％-73.6％）和31.2％（95％CI：24.6％-37.9％）。年龄>65岁（P = .006），KPS＜90％（P = .005）和颅外转移（P = .05）都与OS劣质相关。
SRS可取得与常见原发灶相当的LC效果。年龄和KPS与LC和OS有关，计划靶体积和颅外转移与LC和OS有关。这些因素应在选择接受SRS治疗的GI癌症患者时予以考虑。
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There are limited data regarding outcomes for patients with gastrointestinal (GI) primaries and brain metastases treated with stereotactic radiosurgery (SRS).To examine clinical outcomes after SRS for patients with brain metastases from GI primaries and evaluate potential prognostic factors.The International Radiosurgery Research Foundation centers were queried for patients with brain metastases from GI primaries managed with SRS. Primary outcomes were local control (LC) and overall survival (OS). Kaplan-Meier analysis was used for univariate analysis (UVA) of prognostic factors. Factors significant on UVA were evaluated with a Cox multivariate analysis proportional hazards model. Logistic regressions were used to examine correlations with RN.We identified 263 eligible patients with 543 brain metastases. Common primary sites were rectal (31.2%), colon (31.2%), and esophagus (25.5%) with a median age of 61.6 years (range: 37-91.4 years) and a median Karnofsky performance status (KPS) of 90% (range: 40%-100%). One-year and 2-year LC rates were 83.5% (95% CI: 78.9%-87.1%) and 73.0% (95% CI: 66.4%-78.5%), respectively. On UVA, age >65 years (P = .001), dose <20 Gy (P = .006) for single-fraction plans, KPS <90% (P < .001), and planning target volume ≥2cc (P = .007) were associated with inferior LC. All factors other than dose were significant on multivariate analysis (P ≤ .002). One-year and 2-year OS rates were 68.0% (95% CI: 61.5%-73.6%) and 31.2% (95% CI: 24.6%-37.9%), respectively. Age > 65 years (P = .006), KPS <90% (P = .005), and extracranial metastases (P = .05) were associated with inferior OS.SRS resulted in comparable LC with common primaries. Age and KPS were associated with both LC and OS with planning target volume and extracranial metastases correlating with LC and OS, respectively. These factors should be considered in GI cancer patient selection for SRS.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.