JAMAOncology全脑放疗延长部分脑转移癌症患者生存期.pptxVIP

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2019-01-11 发布于浙江
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JAMAOncology全脑放疗延长部分脑转移癌症患者生存期.pptx

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;IMPORTANCE It remains uncertain whether treatment with stereotactic radiosurgery (SRS) alone can be safely applied to all patient populations with 1 to 4 brain metastases (BMs) exhibiting heterogeneous prognoses. ;;OBJECTIVE To investigate the feasibility of SRS alone for patients with different prognoses determined by the diagnosis-specific Graded Prognostic Assessment (DS-GPA). ;DESIGN, SETTING, AND PARTICIPANTS A secondary analysis (performed in September 2014) of the Japanese Radiation Oncology Study Group (JROSG) 99-1, a phase 3 randomized trial, comparing SRS alone and whole-brain radiotherapy (WBRT) + SRS conducted in 1999 to 2003. ;DESIGN, SETTING, AND PARTICIPANTS Among a total of 132 patients, 88 with non–small-cell lung cancer (NSCLC) and 1 to 4 BMs were included and poststratified by DS-GPA scores to avoid potential bias from BMs from different primary cancer types. The median follow-up time was 8.05 months. ;Eligible standard 1、KPS score ≥ 70； 2、Age ≥ 18 years； 3、BMs：1-4，derived from a histologically confirmed systemic cancer ； 4、 maximum diameter ≤ 3 cm on contrast-enhanced MRI； 5、 Excluded SCLC、lymphoma、 germinoma、 and multiple myeloma。;Stratified 1、 primary tumor site (lung vs other sites), 2、number of BMs (single vs 2-4), 3、the status of extracranial disease (controlled vs uncontrolled).;;;INTERVENTIONS The WBRT schedule was 30 Gy in 10 fractions over 2 to 2.5 weeks. The mean SRS dose was 21.9 Gy in SRS alone and 16.6 Gy in WBRT + SRS.;Statistical Analyses ;;OS, Brain Tumor Recurrence, and Toxic Effects 47patients had a favorable prognosis, with DS-GPA scores of 2.5 to 4.0(26 SRS-alone and 21 WBRT + SRS [DS-GPA 2.5-4.0 group]), and 41 had an unfavorable prognosis, with DS-GPA scores of 0.5 to 2.0 (19 SRS-alone and 22