Adjuvant whole-brain radiation therapy after surgical resection of single brain metastases

被引:46
|
作者
McPherson, Christopher M. [1 ,3 ]
Suki, Dima [1 ,3 ]
Feiz-Erfan, Iman [1 ,3 ]
Mahajan, Anita [2 ,3 ]
Chang, Eric [2 ,3 ]
Sawaya, Raymond [1 ,3 ]
Lang, Frederick F. [1 ,3 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Neurosurg, Houston, TX 77030 USA
[2] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA
[3] Univ Texas MD Anderson Canc Ctr, Brain Tumor Ctr, Houston, TX 77030 USA
关键词
brain metastases; surgical resection; whole-brain radiation therapy; POSTOPERATIVE RADIOTHERAPY; STEREOTACTIC RADIOSURGERY; FAILURE;
D O I
10.1093/neuonc/noq005
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Adjuvant whole-brain radiation therapy (WBRT) after resection of single brain metastases remains controversial. Despite a phase Ill trial to the contrary, clinicians often withhold WBRT after resection of single brain metastases based on the argument that available evidence does not inform regarding treatment of all patients, such as those with radioresistant tumors. However, there is limited information about whether subpopulations benefit equally from WBRT after resection. Therefore, we undertook a retrospective study to determine the clinical, radiographic, and histologic features that influenced the effectiveness of adjuvant WBRT. We reviewed 358 patients with newly diagnosed, single brain metastases, who underwent resection, of which 142 (40%) received adjuvant WBRT and 216 (60%) did not. Median follow-up was 60.1 months. There were multiple tumor histologies, including 197(55%) "radiosensitive" and 161 (45%) "radioresistant" tumors. Compared with observation, WBRT significantly reduced recurrence both locally (HR = 0.58; 95% Cl 0.35-0.98, P = .04) and at distant brain sites (HR = 0.43, 95% Cl 0.30-0.61, P<.001). Multivariate analyses demonstrated that withholding WBRT was an independent predictor of local and distant recurrence. For local recurrence, tumors with a maximum diameter of >= 3 cm that did not receive adjuvant WBRT had an increased risk of recurring locally (HR = 3.14, 95% Cl 1.02-9.69, P =.05). For distant recurrence, patients whose primary disease was progressing and who did not receive WBRT had an Increased risk of distant recurrence (HR = 2.16, 95% Cl 1.01-4.66, P =.05). There was no effect of WBRT based on tumor type. Adjuvant WBRT significantly reduces local and distant recurrences in subsets of patients, particularly those with metastases >3 cm or with active systemic disease.
引用
收藏
页码:711 / 719
页数:9
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