Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis

作者：Giuseppe Caracciolo Minniti, Enrico Clarke, Gaetano Lanzetta, Mattia Falchetto Osti, Guido Trasimeni, Alessandro Bozzao, Andrea E. Romano, Riccardo Maurizi Enrici · 发表于：Radiation Oncology · 年份：2011 · DOI：10.1186/1748-717x-6-48 · 被引用次数：842 · 研究领域：Brain Metastases and Treatment、Advanced Radiotherapy Techniques、Management of metastatic bone disease

PURPOSE: to investigate the factors affecting survival and toxicity in patients treated with stereotactic radiosurgery (SRS), with special attention to volumes of brain receiving a specific dose (V10 - V16 Gy) as predictors for brain radionecrosis. PATIENTS AND METHODS: Two hundred six consecutive patients with 310 cerebral metastases less than 3.5 cm were treated with SRS as primary treatment and followed prospectively at University of Rome La Sapienza Sant'Andrea Hospital. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS. Univariate and multivariate analysis using a Cox proportional hazards regression model were performed to determine the predictive value of prognostic factors for treatment outcome and SRS-related complications. RESULTS: Median overall survival and brain control were 14.1 months and 10 months, respectively. The 1-year and 2-year survival rates were 58% and 24%, and respective brain control were 43% and 22%. Sixteen patients recurred locally after SRS, with 1-year and 2-year local control rates of 92% and 84%, respectively. On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit. Neurological complications were recorded in 27 (13%) patients. Severe neurological complications (RTOG Grade 3 and 4) occurred in 5.8% of patients. Brain radionecrosis occurred in 24% of treated lesions, being symptomatic in 10% and asym...