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1.
Wiggenraad R Verbeek-de Kanter A Mast M Molenaar R Kal HB Lycklama à Nijeholt G Vecht C Struikmans H 《Strahlentherapie und Onkologie》2012,188(8):696-701
Purpose
The 1-year local control rates after single-fraction stereotactic radiotherapy (SRT) for brain metastases >?3?cm diameter are less than 70%, but with fractionated SRT (FSRT) higher local control rates have been reported. The purpose of this study was to compare our treatment results with SRT and FSRT for large brain metastases.Materials and methods
In two consecutive periods, 41?patients with 46?brain metastases received SRT with 1 fraction of 15?Gy, while 51?patients with 65?brain metastases received FSRT with 3?fractions of 8?Gy. We included patients with brain metastases with a planning target volume of >?13?cm3 or metastases in the brainstem.Results
The minimum follow-up of patients still alive was 22?months. Comparing 1?fraction of 15?Gy ?with 3?fractions of 8?Gy, the 1-year rates of freedom from any local progression (54% and 61%, p?=?0.93) and pseudo progression (85% and 75%, p?=?0.25) were not significantly different. Overall survival rates were also not different.Conclusion
The 1-year local progression and pseudo progression rates after 1 fraction of 15?Gy or 3?fractions of 8?Gy for large brain metastases and metastases in the brainstem are similar. For better local control rates, FSRT schemes with a higher biological equivalent dose may be necessary. 相似文献2.
K. A. Hartmann W. Audretsch U. M. Carl S. Gripp C. Kolotas K. Muskalla M. Rezai T. Schnabel I. Waap N. Zamboglou G. Schmitt 《Strahlentherapie und Onkologie》1997,173(10):519-523
Aim
The aim of this protocol was to investigate breast conservation rates with and without flap-supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia.Patients and Methods
One hundred and fifty-eight patients with stage IIA-IV breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. Radiation treatment consisted of an interstitial boost of 10 Gy192Ir-afterloading therapy and a course of external beam radiotherapy of 50 Gy, using 5 × 2 Gy/week. Local hyperthermia with 43.5–44.5°C over 60 minutes was delivered immediately before interstitial radiotherapy.Results
One hundred and forty-two patients underwent salvage surgery. A breast-conserving approach was possible in 74 patients (52%). Fifty-three patients (37%) underwent flap-supported surgery. After a median follow-up of 20 months, one patient developed isolated local recurrence. In 14 cases, locoregional recurrences occurred in combination with distant metastases.Conclusion
In about 50%, breast conservation was achieved by chemotherapy, radiotherapy and hyperthermia. The low isolated local recurrence rate of 0.6% (1/158) has to be substantiated by further follow-up. 相似文献3.
L. Gerdan B. Segedin V. Nagy M.T. Khoa N.T. Trang S.E. Schild D. Rades M.D. 《Strahlentherapie und Onkologie》2014,190(1):64-67
Background and purpose
This study investigated the potential prognostic value of the number of involved extracranial organs in patients with brain metastasis from non-small cell lung cancer (NSCLC).Material and methods
A total of 472 patients who received whole-brain radiotherapy (WBRT) alone with 5?×?4 Gy or 10?×?3 Gy for brain metastasis from NSCLC were included in this retrospective study. In addition to the number of involved extracranial organs, 6 further potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), number of brain metastases, and the interval from cancer diagnosis to WBRT. Subgroup analyses were performed for patients with metastatic involvement of one (lung vs. bone vs. other metastasis) and two (lung?+?bone vs. lung?+?lymph nodes vs. other combinations) extracranial organs.Results
The survival rates at 6 months of the patients with involvement of 0, 1, 2, 3, and ≥?4 extracranial organs were 52, 27, 17, 4, and 14?%, respectively (p?<?0.001). On multivariate analysis, the number of involved extracranial organs remained significant (risk ratio 1.32; 95?% confidence interval 1.19–1.46; p?<?0.001). Age <?65 years (p?=?0.004), KPS ≥?70 (p?<?0.001), and only 1–3 brain metastases (p?=?0.022) were also significantly associated with survival in the multivariate analysis. In the separate analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the pattern of extracranial organ involvement.Conclusion
The number of involved extracranial organs is an independent prognostic factor of survival in patients with brain metastasis from NSCLC, irrespective of the pattern of extracranial organ involvement. 相似文献4.
Purpose
Renal cell carcinomas are relatively radioresistant. After macroscopically incomplete tumor resection conventional external beam radiotherapy is dose-limited and additional systemic treatment with chemotherapy ineffective to achieve local control. In a pilot study the role of intraoperative radiotherapy in the treatment of locally advanced or recurrent renal cell carcinomas was analysed.Patients and Method s
From January 1992 to July 1994 11 patients with a primary (n=3) or recurrent renal cell carcinoma had IORT. One patient had complete resection and in 3 respectively 7 patients microscopically or macroscopically residual disease was left. Using 6 to 10 MeV, a single dose of 15 to 20 Gy was delivered to the fossa renalis and the corresponding paraaortic area. Based on three-dimensional treatment planning, additional external beam radiotherapy was given 3 to 4 weeks later (40) Gy, 2 Gy SD, 23 MV).Results
After a mean follow-up of 24.3 months 5 patients had died of distant metastases (lung, liver, bone, mediastinum) with a mean survival time of 11.5 months. Mean disease-free interval was 6.4 months. One patient suffered from a second malignancy. Two patients are alive with distant metastases. Local tumor control in the entire group was 100%. The calculated 4-year overall and disease-free survival was 47% and 34%. The postoperative course was affected in 3 patients (abscess n=1, short dehiscence of the abdominal wound n=2). The gastrointestinal toxicity during external beam radiotherapy was low. No IORT-specific late adverse effects were observed.Conclusion
After incomplete tumor resection local tumor control with minimal therapy related side effects could be achieved using intraoperative radiotherapy. With IORT the dose limitation in the radiotherapy of renal cell carcinoma could be overcome. The high distant metastases rate relativized overall prognosis. The low morbidity rate justifies further evaluation of this technique. 相似文献5.
Klaus -Rüdiger Trott 《Strahlentherapie und Onkologie》1997,173(3):141-145
Purpose
Tumor regression is one of the most important factors determinating the tumor control probability after radiotherapy. The changes in the regression of tumors during fractionated radiotherapy and the application of different radioprotectors or radiosensitizerse make render to assess their effectivity.Material and Method
The effect of hypoxic breathing (8,1% O2) on the tumor regression of Yoshida sarcoma was studied using rats of Wistar strain. Different fractionation schedules were used: 10×3 Gy, 6×5 Gy and 3×10 Gy.Results
No significant changes in the tumor regression after radiotherapy in any group in any time independent from respiratoric hypoxia were recorded. The tumor regression rate was significantly influenced by treatment schedule (p<0.0005).Conclusions
Our results support the hypothesis of hypoxy-radiotherapy. The acute hypoxic hypoxia, caused due the breathing of hypoxic gas mixture with 8 to 10% oxygen, did not influence the radiation induced tumor regression in animal experiment. For this criterium no protection can be shown. The influence of hypoxy-radiotherapy on the local tumor control is necessary to evaluate in further experiments. 相似文献6.
Allen AM Ben-Ami M Reshef A Steinmetz A Kundel Y Inbar E Djaldetti R Davidson T Fenig E Ziv I 《European journal of nuclear medicine and molecular imaging》2012,39(9):1400-1408
Purpose
Early assessment of tumor response to therapy is vital for treatment optimization for the individual cancer patient. Induction of apoptosis is an early and nearly universal effect of anticancer therapies. The purpose of this study was to assess the performance of 18F-ML-10, a novel PET radiotracer for apoptosis, as a tool for the early detection of response of brain metastases to whole-brain radiation therapy (WBRT).Materials and methods
Ten patients with brain metastases treated with WBRT at 30?Gy in ten daily fractions were enrolled in this trial. Each patient underwent two 18F-ML-10 PET scans, one prior to the radiation therapy (baseline scan), and the second after nine or ten fractions of radiotherapy (follow-up scan). MRI was performed at 6–8?weeks following completion of the radiation therapy. Early treatment-induced changes in tumor 18F-ML-10 uptake on the PET scan were measured by voxel-based analysis, and were then evaluated by correlation analysis as predictors of the extent of later changes in tumor anatomical dimensions as seen on MRI scans 6–8?weeks after completion of therapy.Results
In all ten patients, all brain lesions were detected by both MRI and the 18F-ML-10 PET scan. A highly significant correlation was found between early changes on the 18F-ML-10 scan and later changes in tumor anatomical dimensions (r?=?0.9).Conclusion
These results support the potential of 18F-ML-10 PET as a novel tool for the early detection of response of brain metastases to WBRT. 相似文献7.
Background
About 40% of patients with brain metastases have a very limited number of lesions and may be candidates for radiosurgery. Radiosurgery alone is superior to whole-brain radiotherapy (WBRT) alone for control of treated and new brain metastases. In patients with a good performance status, radiosurgery also resulted in better survival. However, the question is whether the results of radiosurgery alone can be further improved with additional WBRT.Methods
Information for this review was compiled by searching the PubMed and MEDLINE databases. Very important published meeting abstracts were also considered.Results
Based on both retrospective and prospective studies, the addition of WBRT to radiosurgery improved control of treated and new brain metastases but not survival. However, because a recurrence within the brain has a negative impact on neurocognitive function, it is important to achieve long-term control of brain metastases.Conclusion
The addition of WBRT provides significant benefits. Further randomized studies including adequate assessment of neurocognitive function and a follow-up period of at least 2?years are needed to help customize the treatment for individual patients. 相似文献8.
D. Greto F. Paiar C. Saieva A. Galardi M. Mangoni L. Livi B. Agresti D. Franceschini P. Bonomo V. Scotti B. Detti F. Tonelli A. Valeri L. Messerini G. Biti 《La Radiologia medica》2013,118(4):570-582
Purpose
The aim of this study was to evaluate the rate of pathological response (PR), disease control and safety of neoadjuvant chemotherapy using oxaliplatin (OX) and 5-fluorouracil (5-FU) with concurrent radiotherapy for treating locally advanced rectal cancer.Materials and methods
Between November 2002 and December 2010, 90 patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) were retrospectively analysed. All patients underwent preoperative radiotherapy (45 Gy in 1.8-Gy fractions) with concurrent OX (80 mg/m2 i.v., day 1) and a 120-h continuous infusion of 5-FU (1,000 mg/m2 per day). Surgery was performed within 6 weeks after completion of CRT treatment.Results
Complete pathological response was obtained in six patients (6.7%), and 39 (43.3%) had their disease downstaged. The median follow-up period was 4.7 years (6 months to 9 years). Local recurrence occurred in two patients (2.2%), one of whom developed also liver metastases. Distant metastases not associated with local relapse occurred in 23 (25.6%) patients. Overall (OS) and disease-free (DFS) survival were 62.9% and 52.8%, respectively. CRT was well tolerated, with only one grade 3 (1.2%) haematological toxicity (neutropaenia).Conclusions
Neoadjuvant systemic chemotherapy based on OX and 5-UC associated with radiotherapy is well tolerated, with good results in terms of pathological response, disease control and survival, in rectal cancer patients. 相似文献9.
Prof. Dr. M. Kocher H. Treuer M. Hoevels R. Semrau V. Sturm R.-P. Mueller 《Strahlentherapie und Onkologie》2013,189(2):137-141
Purpose
To find out whether the use of stereotactic techniques for fractionated radiotherapy reduces toxicity to the endocrine and visual system in patients with benign perioptic tumors.Patients and methods
From 1993 to 2009, ?29 patients were treated with fractionated stereotactic radiotherapy. The most frequent tumor types were grade I meningioma (n ?=?11) and pituitary adenoma (n ?=?10, 7 nonfunctioning, 3 growth hormone-producing). Patients were immobilized with the GTC frame (Radionics, USA) and the planning target volume (PTV; median 24.7, 4.6–58.6 ml) was irradiated with a total dose of 52.2 Gy (range, 45.0–55.8 Gy) in 1.8-Gy fractions using a linear accelerator (6 MeV photons) equipped with a micro-multileaf collimator. Maximum doses to the optic system and pituitary gland were 53.4 Gy (range, 11.5–57.6 Gy) and 53.6 Gy (range, 12.0–57.9 Gy).Results
Median follow-up was 45 months (range, 10–105 months). Local control was achieved in all but 1 patient (actuarial rate 92% at 5 years and 10 years). In 9 of 29 patients (31%), partial remission was observed (actuarial response rate 40% at 5 years and 10 years). In 4 of 26 patients (15%) with at least partial pituitary function, new hormonal deficits developed (actuarial rate 21% at 5 years and 10 years). This rate was significantly higher in patients treated for a larger PTV (<?/>?25 ml: 0% vs. 42% at 5 years and 10 years, p?=?0.028). Visual function improved in 4 of 15 patients (27%) who had prior impairment. None of the patients developed treatment-related optic neuropathy, but 2 patients experienced new disease-related visual deficits.Conclusion
Fractionated stereotactic radiotherapy for benign tumors of the perioptic and sellar region results in satisfactory response and local control rates and does not affect the visual system. The assumption that patients can be spared hypophyseal insufficiency only holds for small tumors. 相似文献10.
Pia Huguenin Christoph Glanzmann Daniel Taussky Urs Martin Lütolf Stephan Schmid Kris Moe 《Strahlentherapie und Onkologie》1998,174(8):397-402
Purpose
To assess the survival rate, the probability of local control, the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy (RT) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck.Methods
From 1988 to 1994, 64 patients (median age 55.5 years) with carcinomas of different subsites, excluding the nasopharynx, were treated in a pilot study with 1.2 Gy bid (6 h interval; total dose 74.4 Gy) and simultaneous CDDP (20 mg/m2 daily, 5 days in week 1 and 5) and followed at regular intervals. Overall survival and local control, as well as the rates of late toxicity, were estimated using the actuarial method. Median follow-up was 3.3 years for all and 5.2 years for surviving patients. To assess the quality of life, the EORTC QLQ-C 30 questionnaire and the H&N35 module questionnaire were sent to the patients surviving with no evidence of disease or second primary tumors; they were answered by 15/23 (67%).Results
Overall survival was 37% at 5 years, whereas disease-specific survival was 59%. Twenty-three patients died from uncontrolled head and neck cancer. Second primary tumors were observed in 13 patients, most frequently in the lung. Local control without salvage surgery was 74% at 5 years for all subsites and stages, and loco-regional disease-free survival was 72%. Eleven patients developed distant metastases, which was the only site of failure in 6 cases. Salvage surgery was successful in 2 cases. The actuarial estimates of ≥ grade-3 late toxicity was 4% for the mandibular bone and 23% for dysphagia, and 50% of the patients experienced a permanent xerostomy. Self-reported global quality of life in surviving patients was good (mean 68 points on a scale 0 to 100); consequences of impaired salivary function had most impact on nutritional and social aspects.Conclusions
Hyperfractionated RT with concomitant CDDP is well tolerated and highly efficient in controlling moderately advanced to advanced cancers of the head and neck. Second primary tumors are the main cause of death after 3 years and were observed outside of the irradiated area, most frequently in the lung. Even after RT of large volumes to a high dose, salvage surgery can be successfully performed in individual cases. Self-reported quality of life of surviving patients is good, despite xerostomy-associated nutritional difficulties. 相似文献11.
J. Broemme J. Abu-Isa R. Kottke J. Beck R. Wiest M. Malthaner D. Schmidhalter A. Raabe D.M. Aebersold A. Pica M.D 《Strahlentherapie und Onkologie》2013,189(9):765-770
Background
Tumor bed stereotactic radiosurgery (SRS) after resection of brain metastases is a new strategy to delay or avoid whole-brain irradiation (WBRT) and its associated toxicities. This retrospective study analyzes results of frameless image-guided linear accelerator (LINAC)-based SRS and stereotactic hypofractionated radiotherapy (SHRT) as adjuvant treatment without WBRT.Materials and methods
Between March 2009 and February 2012, 44 resection cavities in 42 patients were treated with SRS (23 cavities) or SHRT (21 cavities). All treatments were delivered using a stereotactic LINAC. All cavities were expanded by ≥?2 mm in all directions to create the clinical target volume (CTV).Results
The median planning target volume (PTV) for SRS was 11.1 cm3. The median dose prescribed to the PTV margin for SRS was 17 Gy. Median PTV for SHRT was 22.3 cm3. The fractionation schemes applied were: 4 fractions of 6 Gy (5 patients), 6 fractions of 4 Gy (6 patients) and 10 fractions of 4 Gy (10 patients). Median follow-up was 9.6 months. Local control (LC) rates after 6 and 12 months were 91 and 77?%, respectively. No statistically significant differences in LC rates between SRS and SHRT treatments were observed. Distant brain control (DBC) rates at 6 and 12 months were 61 and 33?%, respectively. Overall survival (OS) at 6 and 12 months was 87 and 63.5?%, respectively, with a median OS of 15.9 months. One patient treated by SRS showed symptoms of radionecrosis, which was confirmed histologically.Conclusion
Frameless image-guided LINAC-based adjuvant SRS and SHRT are effective and well tolerated local treatment strategies after resection of brain metastases in patients with oligometastatic disease. 相似文献12.
Blecharz P Urbański K Mucha-Ma?ecka A Ma?ecki K Reinfuss M Jakubowicz J Skotnicki P 《Strahlentherapie und Onkologie》2011,187(12):806-811
Aims
The aim of this study was to present the characteristics, methods of treatment, and the survival of patients with hematogenous metastases from endometrial carcinoma, free from local and other distant recurrences.Patients and Methods
In 1,610 endometrial carcinoma patients managed with surgery and postoperative radiotherapy, we defined hematogenous metastases as a tumor spread to the lung or other sites via hematogenous routes.Results
A total of 110 patients with stage I and II endometrial carcinoma, presenting with 134 metastases sites (69 in the lungs, 32 in the liver, 23 in the bones, and 10 in the brain), were observed. Progestin and combination chemotherapy were the most commonly used therapies. Primary treatment consisted of surgery in patients with solitary metastases to the lung (30 patients), liver (2 patients), and brain (2 patients). Radiotherapy was performed in 32 patients with metastases to the brain and bones. Presenting with a 36-month survival rate were 11.6% (8/69) of patients with metastases to the lungs, 6.3% (2/32) of patients with metastases to the liver, 8.7% (2/23) of patients with metastases to the bones, and 20.0% (2/10) of patients with metastases to the brain.Conclusions
Hormonal therapy and chemotherapy play a major role in the palliative management of patients with hematogenous metastases from endometrial carcinoma to the liver, lungs, and bones. Radical treatment in patients with metastases to the lung or liver consists of resection of the metastasis combined with chemo- and/or hormonotherapy for metastases to the bones treatment consists of radiotherapy + chemotherapy, for metastasis to the brain treatment consists of resection combined with radiotherapy. 相似文献13.
L.H. Dröge M.D. T. Hinsche M.D. M. Canis M.D. B. Alt-Epping M.D. C.F. Hess M.D. PhD H.A. Wolff M.D. 《Strahlentherapie und Onkologie》2014,190(2):199-203
Background and purpose
Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity.Patients and methods
A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed.Results
Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1?% responded to radiotherapy with 10.8?% in complete remission, 48.6?% with good response and 21.6?% with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months.Conclusion
The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting. 相似文献14.
15.
Background
Despite an increasing number of reports Merkel-cell-carcinoma still is a rare neoplasm. Reports on radical radiotherapy are sparse.Patient and Method
We report on a successful radical radiotherapy of a recurrent Merkel-cell-carcinoma of the eyelid in an 84-year old woman, using a hypofractionated treatment of 50 Gy with 70 kV-X-rays, 10 fractions of 5 Gy within 5 weeks.Result
Rapid and complete remission was achieved, with no signs of local or distant failure 24 months after the end of therapy.Conclusion
The case reported on highlights the radiosensitivity of this tumor and the role of radiotherapy not merely as salvage procedure. 相似文献16.
Birgit Materlik Ursula Steidle-Katic Bernd Wauschkuhn Thomas Feyerabend Eckart Richter 《Strahlentherapie und Onkologie》1998,174(9):478-481
Purpose
Extracranial metastases of malignant gliomas are rare. We report 2 cases with spinal metastases in patients suffering from glioma.Patients and Method
Two patients (33 and 57 years old) developed spinal canal metastases of a glioblastoma multiforme and anaplastic astrocytoma Grade III respectively 25 and 9 months after surgical resection and radiotherapy. Both metastases were confirmed pathohistologically.Results
Intraspinal metastases were irradiated with a total dose of 12.6 Gy and 50 Gy. Treatment withdrawal was necessary in one patient due to reduced clinical condition. Regression of neurological symptoms was observed in the second patient.Conclusions
Spinal spread of malignant glioma should be considered during care and follow-up in glioma patients with spinal symptoms. 相似文献17.
M. Hata MD T. Taguchi I. Koike G. Nishimura M. Takahashi M. Komatsu D. Sano K. Odagiri Y. Minagawa T. Inoue 《Strahlentherapie und Onkologie》2013,189(1):26-32
Background and purpose
Primary subglottic cancer is a rare malignancy. We investigated the efficacy and toxicity of radiotherapy for subglottic cancer.Patients and methods
Nineteen patients with primary squamous cell carcinoma of the subglottis received radiotherapy, 14 of whom also underwent chemotherapy. Of the 19 patients, 15 received definitive radiotherapy to the gross tumors with total doses of 70–70.2 Gy in 35–39 fractions, and 4 underwent preoperative radiotherapy with total doses of 37.8–55.8 Gy in 21–31 fractions, followed by total laryngectomy.Results
Of the 19 patients, 5 developed local progression and 2 developed distant metastasis at the median follow-up period of 5 years. The 5-year local control and disease-free rates were 74 and 63%, respectively. Three patients died of tumor progression, and the 5-year overall and disease-free survival rates were 80 and 63%, respectively. Regarding acute toxicities, transient mucositis and dermatitis of grade 3 or lower were observed in all patients, but there were no late toxicities of grade 3 or higher.Conclusion
Radiotherapy is a safe and effective treatment for patients with primary squamous cell carcinoma of the subglottis. The use of chemotherapy together with radiotherapy may enhance treatment efficacy and contribute to larynx preservation through good local control. 相似文献18.
Fodor A Fiorino C Dell'Oca I Broggi S Pasetti M Cattaneo GM Gianolli L Calandrino R Di Muzio NG 《Strahlentherapie und Onkologie》2011,187(11):736-743
Purpose
To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM).Patients and Methods
A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV).Results
Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2?C10 weeks. Median overall survival was 8 months (1.2?C50.5 months) and 20 months (4.3?C33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003).Conclusions
The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection. 相似文献19.
Dirk Rades M.D. Dagmar Hornung Oliver Blanck Kristina Martens Mai Trong Khoa MD PhD Ngo Thuy Trang MD Michael Hüppe Patrick Terheyden Jan Gliemroth Steven E. Schild 《Strahlentherapie und Onkologie》2014,190(9):786-791
Background and purpose
Three doses were compared for local control of irradiated metastases, freedom from new brain metastases, and survival in patients receiving stereotactic radiosurgery (SRS) alone for one to three newly diagnosed brain metastases.Patients and methods
In all, 134 patients were assigned to three groups according to the SRS dose given to the margins of the lesions: 13–16 Gy (n?=?33), 18 Gy (n?=?18), and 20 Gy (n?=?83). Additional potential prognostic factors were evaluated: age (≤?60 vs. >?60 years), gender, Karnofsky Performance Scale score (70–80 vs. 90–100), tumor type (non-small-cell lung cancer vs. melanoma vs. others), number of brain metastases (1 vs. 2–3), lesion size (15 vs. ≥?15 mm), extracranial metastases (no vs. yes), RPA class (1 vs. 2), and interval of cancer diagnosis to SRS (≤?24 vs. >?24 months).Results
For 13–16 Gy, 18 Gy, and 20 Gy, the 1-year local control rates were 31, 65, and 79?%, respectively (p?0.001). The SRS dose maintained significance on multivariate analysis (risk ratio: 2.25; 95?% confidence interval: 1.56–3.29; p?0.001). On intergroup comparisons of local control, 20 Gy was superior to 13–16 Gy (p?0.001) but not to 18 Gy (p?=?0.12); 18 Gy showed a strong trend toward better local control when compared with 13–16 Gy (p?=?0.059). Freedom from new brain metastases (p?=?0.57) and survival (p?=?0.15) were not associated with SRS dose in the univariate analysis.Conclusion
SRS doses of 18 Gy and 20 Gy resulted in better local control than 13–16 Gy. However, 20 Gy and 18 Gy must be compared again in a larger cohort of patients. Freedom from new brain metastases and survival were not associated with SRS dose. 相似文献20.
Dr. B. van Oorschot B. Assenbrunner M. Schuler G. Beckmann M. Flentje 《Strahlentherapie und Onkologie》2014,190(3):270-275