Clinical Researches About Stereotactic Radiotherapy Of Brain Metastases

Objective To summarize the results of stereotactic radiation therapy (SRT) with or without whole-brain radiotherapy (WBRT) in the treatment of multiple brain metastasis.Methods From May1995to April2010, totally98patients with newly diagnosed multiple (2-13lesions) brain metastases were treated in our centre. Forty-four patients were treated with SRT alone and54with SRT+WBRT. Dose fractionation schemes were15-26Gy in1fraction or24.0-52.5Gy in2-15fractions with3.5-12.0Gy per fraction, which varied depending on the tumor volume, location, and history of prior irradiation. Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis. The median age of the whole group was55years. The survival time was calculated from the date of radiation treatment to the day of death by any cause.Results The median follow-up time for the whole group was12months, and the follow-up rate was100%.The median overall survival time was13.5months for the whole group, there was no difference between SRT alone group and SRT+WBRT group (13m vs.13.5m, x2=0.309,P=0.578). The status of extracranial metastases(p=0.040),the Karnofsky Performance Score (KPS) at the time of treatment (P=0.012), and the interval between the diagnosis of the primary tumor and brain metastases (P=0.025) were independent prognosis factors for survival in multivariate analyses. The distant brain tumour recurrence rate were47.7%in the SRT group and24.1%in the SRT+WBRT group (p=0.018),52.3%patients were free from distant brain tumour metastasis in the SRT group and need no WBRT any more in their lifespan.Conclusions Stereotactic radiation therapy is an effective treatment modality for multiple brain metastases and is another optional modality for multiple brain metastasis. Objective To explore the risk factors of distant brain failure (DBF) for patients with brain metastasis (BM) who were treated with stereotactie radiotherapy alone and to group the patients on the basis of their risk levels.Methods and Materials We retrospectively analyzed132newly diagnosed BM patients who were treated with stereotactie radiotherapy alone from May2000to April2010. Kaplan-Meier and Cox proportional hazards regression analyses were performed for univariate and multivariate analyses.Results The1-year incidence rate of DBF was44.8%, and the median DBF time (MDBFT) was18months. In univariate analysis, the risk factors of DBF were the number of BMs greater than1(p=0.004,X2=8.751), uncontrolled extracranial disease (p=0.003,X2=8.900), interval time (IT) of less than60months between the diagnosis of primary tumor and BM (p=0.012,X2=6.523), the KPS score was70(p=0.007,X2=6.850), and total volume of BM was greater than6cc (p=0.015,X-=5.290). But in multivariate analysis, the KPS scores were not an independent risk factor for DBF(p=0.081). Each of the other four risk factors was assigned1score. The median survival times for the patients with scores of0-1,2-3, and4were31,12, and10months, respectively, and the corresponding MDBFTs were not reached,15, and3months, respectively,(p<0.001). The crude DBF incidence rates in patients with scores of0-1,2-3, and4were14.8%,48.4%, and80.0%, respectively,(p<0.001).Conclusions The patients with scores of0-1had a lower risk of DBF than the patients with higher scores did, and it may be reasonable to treat these patients with SRS alone and resort to whole-brain radiation therapy only for salvage. The patients with a score of4had the highest risk of developing DBF after stereotactie radiotherapy alone, these patients may be candidates for initial whole-brain radiation therapy or clinical trials. The patients with a score of2-3had a moderate risk of developing DBF, SRT alone combined with close clinical monitoring would be the optimal treatment regimen for such patients, and for those patients with difficulties in receiving close clinical momitoring,SRT combined with WBRT will be more suitable. Objective To explore the outcome of stereotactic radiotherapy (SRT) for brain metastases of patients with low Karnofsky Performance Scale (KPS) scores (KPS≤60).Methods and Materials Fifty-eight consecutive patients with metastatic brain tumors and Karnofsky performance scale (KPS) scores≤60treated with SRT from January2000to July2010in our center. Two of them were lost in follow-up, and the other fifty-six patients were all involved in the analysis. Poor performance status was caused by presence of intracranial metastases in28cases (50.0%),uncontrolled extracerebral disease in26cases (46.4%) and resulted from non-tumor related disease in2cases (3.6%). Stereotactic radiotherapy were delivered as the initial treatment in29cases, as salvage treatment after the failure of whole brain radiotherapy(WBRT) in19cases and as a boost to the residual tumor of WBRT in8cases. Kaplan-Meier and Cox proportional hazards regression analyses were performed for univariate and multivariate analyses.Results The median age of the whole group was55. The median overall survival time was13.5months and the median intracranial symptom-control time was3.5months for the whole group. The cause of low Karnofsky Performance Scale score (p=0.016, X2=8.309),GPA classes(p=0.048,X2=3.919) and the status of extracranial diseases(p=0.023,X2=5.170) were significant factors for the survival of brain metastatic patients in univariat analysis. But in multivariate analysis, only the cause of low Karnofsky Performance Scale score (p=0.026,RR=4.44,95%CI1.036-20.818) was independent prognosis factor for survival.Conclusions The cause of low Karnofsky Performance Scale score was the independent prognosis factor for the survival of brain metastatic patients with poor performance status, the patients whose low Karnofsky Performance Scale score was resulted in the presence of intracranial diseases woule probably have a longer survival time. Objective To explore the prognostic factors of brain metastases from primary breast cancer treated with stereotactic radiotherapy.Materials and Methods Retrospectively analyze37brain metastatic patients from primary breast cancer. twenty-seven patients were newly-diagnosed brain metastasis, among these patients nineteen were treated with stereotactic radiotherapy alone,eight patients were treated with whole brain radiotherapy plus stereotactic radiotherapy.The other ten patients were with intracranial recurrence after whole brain radiotherapy and treated with stereotactic radiotherapy for salvage. Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis.Results The median age for the whole group was49.The median overall survival time was13.5months for the whole group. In univariate analysis, The triple negative breast cancer (p=0.004, X2=5.948),lower Karnofsky Performance Score (p<0.001, X2=13.847), the interval between the diagnosis of the primary tumor and brain metastases<30months(p=0.010, X2=6.618),high RPA grade(p<0.001, X2=15.350)and intracranial recurrence after whole brain radiotherapy (p=0.035, X2=,4.428) were negative prognostic factor for brain metastasis from primary breast cancer treated with stereotactic radiotherapy. In multivariate analyses, only the triple negative breast cancer (p=0.008, X2=9.577),lower Karnofsky Performance Score (p=0.010, X2=6.652), and intracranial recurrence after whole brain radiotherapy (p=0.047, X2=3.953) were negative prognostic factor.Conclusion the triple negative breast cancer,lower Karnofsky Performance Score, and intracranial recurrence after whole brain radiotherapy were negative prognostic factor for brain metastasis from primary breast cancer treated with stereotactic radiotherapy.