Do patients with very few brain metastases from breast cancer benefit from whole-brain radiotherapy in addition to radiosurgery?

详细信息    查看全文

• 作者：Dirk Rades ; Stefan Huttenlocher ; Dagmar Hornung ; Oliver Blanck…
• 关键词：Breast cancer ; Brain metastases ; Radiosurgery ; Whole ; brain radiotherapy ; Freedom from new brain metastases
• 刊名：Radiation Oncology
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：9
• 期：1
• 全文大小：309 KB
• 参考文献：1. Khuntia, D, Brown, P, Li, J, Mehta, MP (2006) Whole-brain radiotherapy in the management of brain metastases. J Clin Oncol 24: pp. 1295-1304 CrossRef
  2. Rades, D, Dziggel, L, Segedin, B, Oblak, I, Nagy, V, Marita, A, Schild, SE, Trang, NT, Khoa, MT (2013) A simple survival score for patients with brain metastases from breast cancer. Strahlenther Onkol 189: pp. 664-667 CrossRef
  3. Rades, D, Dziggel, L, Segedin, B, Oblak, I, Nagy, V, Marita, A, Schild, SE, Trang, NT, Khoa, MT (2013) A new survival score for patients with brain metastases from non-small cell lung cancer. Strahlenther Onkol 189: pp. 777-781 CrossRef
  4. Schüttrumpf, LH, Niyazi, M, Nachbichler, SB, Manapov, F, Jansen, N, Siefert, A, Belka, C (2014) Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1- cerebral metastases. Radiat Oncol 9: pp. 105 CrossRef
  5. Chang, EL, Wefel, JS, Hess, KR, Allen, PK, Lang, FF, Kornguth, DG, Arbuckle, RB, Swint, JM, Shiu, AS, Maor, MH, Meyers, CA (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10: pp. 1037-1044 CrossRef
  6. Kocher, M, Soffietti, R, Abacioglu, U, Villà, S, Fauchon, F, Baumert, BG, Fariselli, L, Tzuk-Shina, T, Kortmann, RD, Carrie, C, Ben Hassel, M, Kouri, M, Valeinis, E, van den Berge, D, Collette, S, Collette, L, Mueller, RP (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-6001 study. J Clin Oncol 29: pp. 134-141 CrossRef
  7. Aoyama, H, Shirato, H, Tago, M, Nakadawa, K, Toyoda, T, Hatano, K, Kenjyo, M, Oya, N, Horota, S, Snioura, H, Kunieda, E, Inomata, T, Hayakawa, K, Katoh, N, Kobashi, G (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases. A randomized controlled trial. JAMA 295: pp. 2483-2491 CrossRef
  8. Sperduto, PW, Chao, ST, Sneed, PK, Luo, X, Suh, J, Roberge, D, Bhatt, A, Jensen, AW, Brown, PD, Shih, H, Kirkpatrick, J, Schwer, A, Gaspar, LE, Fiveash, JB, Chiang, V, Knisely, J, Sperduto, CM, Mehta, M (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 77: pp. 655-661 CrossRef
  9. Jo, KI, Im, YH, Kong, DS, Seol, HJ, Nam, DH, Lee, JI (2013) Gamma knife radiosurgery for brain metastases from breast cancer. J Korean Neurosurg Soc 54: pp. 399-404 CrossRef
  10. Maclean, J, Fersht, N, Singhera, M, Mulholland, P, McKee, O, Kitchen, N, Short, SC (2013) Multi-disciplinary management for patients with oligometastases to the brain: results of a 5?year cohort study. Radiat Oncol 8: pp. 156 CrossRef
  11. Aoyama, H, Tago, M, Kato, N, Toyoda, T, Kenjyo, M, Hirota, S, Shioura, H, Inomata, T, Kunieda, E, Hayakawa, K, Nakagawa, K, Kobashi, G, Shirato, H (2007) Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys 68: pp. 1388-1395 CrossRef
  12. Regine, WF, Scott, C, Murray, K, Curran, W (2001) Neurocognitive outcome in brain metastases patients treated with accelerated-fractionation vs. accelerated-hyperfractionated radiotherapy: an analysis from Radiation Therapy Oncology Group Study 91-4. Int J Radiat Oncol Biol Phys 51: pp. 711-717
• 刊物主题：Oncology; Radiotherapy;
• 出版者：BioMed Central
• ISSN：1748-717X

文摘

Background An important issue in palliative radiation oncology is the whether whole-brain radiotherapy should be added to radiosurgery when treating a limited number of brain metastases. To optimize personalized treatment of cancer patients with brain metastases, the value of whole-brain radiotherapy should be described separately for each tumor entity. This study investigated the role of whole-brain radiotherapy added to radiosurgery in breast cancer patients. Methods Fifty-eight patients with 1- brain metastases from breast cancer were included in this retrospective study. Of these patients, 30 were treated with radiosurgery alone and 28 with radiosurgery plus whole-brain radiotherapy. Both groups were compared for local control of the irradiated metastases, freedom from new brain metastases and survival. Furthermore, eight additional factors were analyzed including dose of radiosurgery, age at radiotherapy, Eastern Cooperative Oncology Group (ECOG) performance score, number of brain metastases, maximum diameter of all brain metastases, site of brain metastases, extra-cranial metastases and the time from breast cancer diagnosis to radiotherapy. Results The treatment regimen had no significant impact on local control in the univariate analysis (p--.59). Age ?9?years showed a trend towards improved local control on univariate (p--.066) and multivariate analysis (p--.07). On univariate analysis, radiosurgery plus whole-brain radiotherapy (p--.040) and ECOG 0- (p--.012) showed positive associations with freedom from new brain metastases. Both treatment regimen (p--.039) and performance status (p--.028) maintained significance on multivariate analysis. ECOG 0- was positively correlated with survival on univariate analysis (p--.001); age ?9?years showed a strong trend (p--.054). On multivariate analysis, performance status (p--.001) and age (p--.041) were significant. Conclusions In breast cancer patients with few brain metastases, radiosurgery plus whole-brain radiotherapy resulted in significantly better freedom from new brain metastases than radiosurgery alone. However, this advantage did not lead to significantly better survival.