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【ASCO 2015】全体大会:有限脑转移患者行全脑放疗,风险大于收益

作者: 来源:医脉通肿瘤科 发布时间:2015-06-04 14:10:57 今日访问/总访问:1|924

在5月31日下午的ASCO全体大会上,美国罗彻斯特Mayo诊所的Paul D. Brown报告的一项研究显示,辅助性全脑放疗对有限脑转移患者的治疗风险大于收益(摘要号LBA4)。医脉通对此进行了报道。


ASCO观点


ASCO专家Michael Alexander评论说:“这项研究将有助于制定目前及未来成千上万患者的治疗决策。作为医生,我们想要给患者最好的,有时给予少的治疗会提供更好的效果。给予放射手术治疗,必须要权衡加入全脑放疗的益处与治疗的风险和副作用,这项研究帮助我们认识到了涉及的利弊。”


研究详情

 

                   Paul D. Brown

 

放射手术(SRS)后予全脑放射治疗(WBRT)可显著提高脑部肿瘤的控制率 ,但辅助WBRT对脑部肿瘤的作用尚待讨论 ,因其有致认知水平下降风险。


有1-3处脑转移(经MRI检测,每个<3厘米)的患者,被随机分配到SRS单独组或SRS +WBRT组,所有患者在治疗前后分别进行认知功能测试,治疗主要终点是认知功能恶化(CP):其被定义为3 个月内6次测试的任意一次,比基线水平下降>1SD 。至CP时间估计,使用累积发病率来评估,并按生存时间进行相应的风险调整。


213 患者入组,其中2例不符合研究要求,3例在接受治疗前被排除。两组患者的基线认知水平无明显差异。患者中位年龄60 岁、原发肿瘤以肺癌最常见(68%)。3个月后出现认知功能恶化的比率,WBRT+SRS组比SRS组比更高(88.0%vs.61.9%,p=0.002)。WBRT+SRS 组瞬间记忆能力较差(31%vs.8%,p=0.007),延迟记忆能力下降(51%和 20%,p=0.002),语言流畅能力下降(19%vs.2%,p=0.02)。6个月内颅内肿瘤控制率,SRS组为66.1%,而WBRT+SRS组是88.3%;12个月颅内肿瘤控制率,两组分别为50.5%和 84.9%(p<0.001)。中位总生存时间,SRS单独治疗组为10.7月,而 SRS +WBRT 组为7.5 个月(HR = 1.02,p=0.93)。


SRS术后加WBRT可致患者认知功能下降,特别是会影响其瞬间记忆能力、延迟记忆能力和语言流畅性。辅助WBRT并没有改善患者的总生存,尽管其有更好的大脑局部控制率。对于初诊拟行SRS术的患者,应密切监测患者的认知功能,以更好地保护其认知功能。


更多精彩内容》》》2015年ASCO年会专题报道


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摘要原文


LBA4: NCCTG N0574 (Alliance): A phase III randomized trial of whole brain radiation therapy (WBRT) in addition to radiosurgery (SRS) in patients with 1 to 3 brain metastases.


Background: WBRT significantly improves tumor control in the brain after SRS, yet the role of adjuvant WBRT remains undefined due to concerns regarding neurocognitive risks.


Methods: Patients with 1-3 brain metastases, each < 3 cm by contrast MRI, were randomized to SRS alone or SRS + WBRT and underwent cognitive testing before and after treatment. The primary endpoint was cognitive progression (CP) defined as decline > 1 SD from baseline in any of the 6 cognitive tests at 3 months. Time to CP was estimated using cumulative incidence adjusting for survival as a competing risk.


Results: 213 patients were enrolled with 2 ineligible and 3 cancels prior to receiving treatment. Baseline characteristics were well-balanced between study arms. The median age was 60 and lung primary the most common (68%). CP at 3 months was more frequent after WBRT + SRS vs. SRS alone (88.0% vs. 61.9% respectively, p = 0.002). There was more deterioration in the WBRT + SRS arm in immediate recall (31% vs. 8%, p = 0.007), delayed recall (51% vs. 20%, p = 0.002), and verbal fluency (19% vs. 2%, p = 0.02). Intracranial tumor control at 6 and 12 months were 66.1% and 50.5% with SRS alone vs. 88.3% and 84.9% with SRS+WBRT (p < 0.001). Median OS was 10.7 for SRS alone vs. 7.5 months for SRS+WBRT respectively (HR = 1.02, p = 0.93).


Conclusions: Decline in cognitive function, specifically immediate recall, memory and verbal fluency, was more frequent with the addition of WBRT to SRS. Adjuvant WBRT did not improve OS despite better brain control. Initial treatment with SRS and close monitoring is recommended to better preserve cognitive function in patients with newly diagnosed brain metastases that are amenable to SRS.

 

 

                        (文章来源于《 医脉通肿瘤科》)