| Objective:Brain metastasis is the late stage of malignant tumor development,and stereotactic radiotherapy is one of the main treatment methods for brain metastasis,which can control the tumor and improve the symptoms at the same time.Single stereotactic radiotherapy(SRS)and fractionated stereotactic radiotherapy(FSRT)are two options for stereotactic radiotherapy,which can be applied according to different situations.The purpose of this study is to explore the feasibility of fractionated stereotactic radiotherapy in the treatment of brain metastases with a diameter of 1-2cm,The second is to analyze the curative effect and survival of one-week interval fractionated stereotactic radiotherapy mode in brain metastases with a diameter of 1-4cm,in order to provide some reference for the treatment interval mode of brain metastases with a diameter of 1-4cm.Methods:TThe clinical data of patients with brain metastases who were treated with gamma knife stereotactic radiotherapy in Cangzhou People’s Hospital from July 2020 to March 2022 were collected.There were 84 patients who met the requirements of the group,with a total of 90 treatments,and 132 lesions were treated in total.Brain metastases with a diameter of 1-2cm were divided into SRS group and FSRT group according to different treatment methods,and the local control rate and radiation necrosis rate after treatment were analyzed and compared between the two groups.The brain metastases with a diameter of 1-4cm were treated with one-week interval therapy,and the therapeutic effect and the survival of patients were summarized.The measurement data were expressed by median,and the rank sum test was used for comparison between groups.The counting data were expressed by percentage,and the comparison between groups was made by test.Kaplan-Meier method was used for survival analysis,survival curve was drawn,Log-rank test was used for univariate analysis,and COX proportional hazard regression model was used for multivariate analysis of prognosis.P<0.05 was statistically significant.Results:1.The local control rates of brain metastases with a diameter of 1-2cm in SRS group were 100%,95.65%,92.54%,87 93%and 87.76%respectively after 1 month,3 months,6 months,9 months and 12 months of treatment,while those in FSRT group were 100%,100%,100%,90.91%and 90%.Fisher exact test was carried out on the local control rate of the two groups at 3 months,6 months,9 months and 12 months after treatment,and the results showed that there was no significant difference between the two groups(P>0.05).The incidence of radiation necrosis in SRS group was 4.35%,7.46%,12.07%and 12.24%at 3,6,9 and 12 months after treatment and in FSRT group was 9.09%and 10%at 9 and 12 months after treatment Fisher exact test was carried out on the incidence of radiation necrosis in the two groups at 3 months,6 months,9 months and 12 months after treatment.The results showed that there was no significant difference between the two groups(P>0.05).The occurrence of radioactive necrosis in FSRT group tends to decrease.2.The local control rates at 1 month,3 months,6 months,9 months and 12 months after the 1-week interval FSRT regimen in patients with brain metastases with a diameter of 1-4 cm were 100%,98.21%,96.15%,84.21%and 82.14%,respectively.The incidence of radiation necrosis in 3 months,6 months,9 months and 12 months after treatment was 1.79%,3.85%,13.15%and 17.86%respectively.The OS rates were 87.2%and 79.5%one year and two years after FSRT treatment,respectively.The PFS rates at 1 year and 2 years after treatment were 74.5%and 66%respectively.The intracranial PFS rates were 76.6%and 64.6%at 1 year and 2 years after treatment,respectively.Univariate analysis and multivariate analysis sugggest that KPS score and combined systemic therapy are the influencing factors of OS after FSRT treatment(P<0.05).Conclusions:1.Fractional stereotactic radiotherapy and single stereotactic radiotherapy have the same local control rate in brain metastases with a diameter of l-2cm,and the incidence of radiation necrosis tends to decrease after fractional treatment,suggesting that it is feasible to apply fractional stereotactic radiotherapy in brain metastases with a diameter of 1-2cm.2.Fractional stereotactic radiotherapy at 1-4cm interval has a good short-term and long-term local control rate for brain metastases,which is a safe and effective treatment method for brain metastases.KPS score and systemic therapy are the influencing factors for the survival of patients with brain metastases with a diameter of 1-4cm under the one-week interval FSRT treatment mode. |
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