结直肠癌脑转移立体定向放射外科手术后的局部控制和生存：国际多中心分析。
Local control and survival after stereotactic radiosurgery for colorectal cancer brain metastases: an international multicenter analysis.
发表日期：2023 Nov 10
作者：
Othman Bin-Alamer, Hussam Abou-Al-Shaar, Raj Singh, Arka N Mallela, Andrew Legarreta, 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 Emad Eldin, 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, Judith Hess, Kelsey Templeton, Xiaoran Zhang, Zhishuo Wei, Stylianos Pikis, Georgios Mantziaris, Gabriela Simonova, Roman Liscak, Selcuk Peker, Yavuz Samanci, Veronica Chiang, Charles R Kersh, Cheng-Chia Lee, Daniel M Trifiletti, Ajay Niranjan, Constantinos G Hadjipanayis, L Dade Lunsford, Jason P Sheehan
来源：
Brain Structure & Function
摘要：
本研究的目的是表征结直肠脑转移立体定向放射外科治疗的局部肿瘤控制（LC）、总生存率（OS）和安全性（CRBM）。参与国际放射外科研究基金会的十家国际机构为这一回顾性病例提供了数据系列。这项研究包括 187 名 CRBM 患者（281 个肿瘤），中位年龄为 62 岁，其中 56.7% 为男性。大多数患者 (53.5%) 患有孤立性肿瘤，但 10.7% 的患者患有 > 5 个肿瘤。中位肿瘤体积为2.7 cm3（IQR 0.22-8.1 cm3），中位边缘剂量为20 Gy（IQR 18-22 Gy）。3年LC和OS率分别为72%和20%。 1.6% 的患者出现症状性放射不良反应。在多变量分析中，年龄 > 65 岁和肿瘤体积 > 4.0 cm3 是肿瘤进展的显着预测因子（风险比 [HR] 2.6，95% CI 1.4-4.9；p = 0.003 和 HR 3.4，95% CI 1.7-6.9； p < 0.001，分别）。更好的体能状态（卡诺夫斯基体能量表评分> 80）与肿瘤进展风险降低相关（HR 0.38，95% CI 0.19-0.73；p = 0.004）。患者年龄 > 62 岁（HR 1.6，95% CI 1.1-2.3；p = 0.03）和存在活动性颅外疾病（HR 1.7，95% CI 1.1-2.4；p = 0.009）与较差的 OS 显着相关。放射外科为大多数 CRBM 提供了较高的 LC 率和较低的症状不良放射效应发生率。 OS 和 LC 有利于具有高功能表现评分和非活动性颅外疾病的年轻患者。
The goal of this study was to characterize local tumor control (LC), overall survival (OS), and safety of stereotactic radiosurgery for colorectal brain metastasis (CRBM).Ten international institutions participating in the International Radiosurgery Research Foundation provided data for this retrospective case series. This study included 187 patients with CRBM (281 tumors), with a median age of 62 years and 56.7% being male. Most patients (53.5%) had solitary tumors, although 10.7% had > 5 tumors. The median tumor volume was 2.7 cm3 (IQR 0.22-8.1 cm3), and the median margin dose was 20 Gy (IQR 18-22 Gy).The 3-year LC and OS rates were 72% and 20%, respectively. Symptomatic adverse radiation effects occurred in 1.6% of patients. In the multivariate analysis, age > 65 years and tumor volume > 4.0 cm3 were significant predictors of tumor progression (hazard ratio [HR] 2.6, 95% CI 1.4-4.9; p = 0.003 and HR 3.4, 95% CI 1.7-6.9; p < 0.001, respectively). Better performance status (Karnofsky Performance Scale score > 80) was associated with a reduced risk of tumor progression (HR 0.38, 95% CI 0.19-0.73; p = 0.004). Patient age > 62 years (HR 1.6, 95% CI 1.1-2.3; p = 0.03) and the presence of active extracranial disease (HR 1.7, 95% CI 1.1-2.4; p = 0.009) were significantly associated with worse OS.Stereotactic radiosurgery offers a high LC rate and a low rate of symptomatic adverse radiation effects for the majority of CRBMs. The OS and LC favored younger patients with high functional performance scores and inactive extracranial disease.