| Objective: Radiotherapy for brain metastases(BMs)can be mainly divided into three types which include whole brain radiotherapy(WBRT),stereotactic radiotherapy(SRT)and whole brain radiotherapy combined with stereotactic radiotherapy(WBRT+SRT).This study explored the best radiotherapy for patients with brain metastases by comparing the efficacy of patients receiving three types of radiotherapy.Method: A total of 80 patients with brain metastases were collected from the Radiotherapy Centre of the Fifth affiliated Hospital of Guangzhou Medical University from March 2019 to January 2022.There were 16 patients treated with whole brain radiotherapy(WBRT)and 20 patients WBRT+SRT,and 44 patients received stereotactic radiation therapy SRT.Kaplan-Meier method was used to compare the intracranial progression-free survival(PFS)and overall survival(OS)of the three groups.The objective response rate(ORR),disease control rate(DCR)were compared by Chi-square test.Univariate and multivariate Cox regression analysis were performed to explore factors affecting overall survival.Results: Compared with the objective intracranial remission rate(ORR)3 months after radiotherapy,there was significant difference between WBRT(16.67%)and SRT(50%),but there was no significant difference between WBRT and WBRT+SRT(50%)(WBRT vs SRT,P=0.041;WBRT vs WBRT+SRT,P=0.075,respectively).The intracranial disease control rate(DCR)of the three radiotherapy methods were91.67%,100% and 94.74%,respectively.There was no significant difference between the WBRT+SRT group,the SRT group and the WBRT group(WBRT vs WBRT+SRT,P=0.375;WBRT vs SRT,P=1.000,respectively).The median intracranial progression-free survival(PFS)in WBRT+SRT group and SRT group was26.7 months and 15.1 months,respectively,while the median PFS in WBRT group was not reached.There were significant differences in OS among the three groups.There were significant differences in OS between WBRT group(median OS was 5.2 month)and WBRT+SRT group(median OS was 18 month)and SRT group(median OS was 10.6 month),but there was no significant difference between WBRT+SRT group and SRT group.Univariate analysis of the factors affecting overall survival showed that the interval between radiotherapy was more than 1 month(HR 1.80295% CI 1.059-3.065,P=0.030),KPS score = 70(HR 0.412 95% CI 0.204-0.832,P=0.013)or KPS score > 70(HR 0.257 95% CI 0.129-0.511,P=0.001),RPA grade III(HR 3.059 95% CI 1.596-5.863,P=0.001).Radiotherapy of primary tumor(HR2.485,95% CI 1.376-4.490,P=0.003)may be independent factors affecting the overall survival of patients.In multivariate analysis,KPS score > 70(HR=0.193,95%CI 0.094-0.398,P=0.001)or KPS score = 70(HR=0.452,95%CI0.224-0.913,P=0.027)were the prognostic factors that significantly improved the overall survival.The interval between radiotherapy > 1 month(HR=2.393,95%CI1.347-4.252,Pure 0.003)was significantly correlated with the decrease of overall survival.There was no significant correlation between primary tumor radiotherapy and the overall survival of patients(P=0.065).Conclusion: WBRT,WBRT+SRT and SRT can delay the intracranial progression of patients with brain metastases,and patients who receive WBRT+SRT and SRT have higher objective remission rates.In all patients with brain metastases,WBRT+SRT and SRT can prolong the overall survival time compared with WBRT,and the interval between radiotherapy,KPS score and RPA grade may be important factors affecting prognosis. |
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