| Background and purpose:Brain metastases are the most common intracranial tumors in adults.It is generally believed that the development of brain metastases often indicates the endstage of the disease,which indicates a poor prognosis and a high mortality rate.Currently,generally acknowledged the local treatment methods for brain metastases include surgery,whole-brain radiotherapy(WBRT),and stereotactic radiotherapy(SRT).With the rapid development of radiation oncology technology,SRT has been widely used in the brain metastases clinical treatment and has gradually become the standard treatment method.The purpose of this article is to summarize the clinical data of SRT(± WBRT)in patients with brain metastases.Based on univariate and multivariate analysis,to make a preliminary exploration on the efficacy,related adverse effects and related prognostic factors of SRT in the treatment of brain metastases.To provide reference for the selection of clinical treatment options for brain metastases in the future.Materials and Methods:22 patients only received SRT,of which 9 patients,a total of 25 lesions received single-fraction stereotactic radiotherapy(SF-SRT),and 13 patients with a total of 26 lesions underwent multiple stereotactic radiation therapy(MF-SRT)),the median BED of SRT is 51.3Gy(23.8-90Gy).The remaining 9 patients,a total of 19 lesions underwent stereotactic radiotherapy combined with whole brain radiotherapy,and the whole brain radiotherapy prescription was 25-40 Gy/10-20 f,the median BED of SRT is 37.5Gy(23.8-60Gy).Efficacy evaluation was performed using WHO solid tumor efficacy RECIST evaluation criteria;radiotherapy side effects were evaluated according to RTOG acute radiation injury classification criteria.SPSS18.0 software was used for statistical analysis,Kaplan-Meier method was used to analyze overall survival(OS)and local control rate(LCR),and log-rank method was used to test the difference between survival curves.Multivariate prognostic analysis was performed using a cox model.P <0.05 indicated statistically significant differences.Results:The median follow-up time was 6 months(1.3-23 months),and the average survival time was 7.2 months.The CR rate was 58.06%,the OS at 6 months was 90.32%(28/31),and the LCR at 6 months was 96.77%(30/31).Kaplan-Meier analysis showed that KPS score and extracranial tumor control status were significantly correlated with the 1-year OS(p = 0.03,p = 0.02).The univariate study results showed that the SRT ± WBRT radiotherapy mode and the radiotherapy dose of SRT had significant influence on 1-year LCR(p=0.02;p=0.04).The univariate analysis showed that the radiotherapy mode combined with WBRT was significantly related to the CNS acute side effects of the radiotherapy(p<0.05).Conclusion:1.SRT treatment of brain metastases could improve local control rate and prolong survival.It might be one of the effective methods for local treatment of brain metastases.2.The KPS score and the status of extracranial tumors before treatment are important factors affecting the OS of patients with brain metastases.The KPS score ≥70 points,effective control of systemic diseases,the higher the overall survival rate.3.SRT combined with WBRT radiotherapy mode and SRT radiotherapy dose have significant correlation with LCR in patients with brain metastases,which can be used as the basis for the selection of clinical treatment options for patients with brain metastases.4.SRT combined with WBRT radiotherapy mode has significant correlation with LCR and has no significant benefit to overall survival in patients with brain metastases,but increased the adverse reactions of the CNS acute radiotherapy. |
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