AbstractObjective To compare the efficacy and side effects of multi-fraction stereotactic radiotherapy (SRT) and single-fraction stereotactic radiosurgery (SRS) in the treatment of brain metastases from colorectal cancer.Methods A total of 98 patients with brain metastases from colorectal cancer searched from the database of Professional Committee of Brain Metastasis of Shanghai Anticancer Association were recruited in this study. Among them, 46 patients weretreated with SRT and 52 patients with SRS. Clinical characteristics of all patients were analyzed between two groups and the local tumor control rate, median survival time and the incidence of radiation-induced brain injury were compared between two groups. Results The objective remission rates (ORR) in the SRT and SRS groups were 76.1% and 67.3%, respectively. The 12-month local tumor control rates were 88.3% and 83.9% between two groups, with no statistical difference (P=0.689). The median overall survival time of all patients was 11.6 months, 10.8 months in the SRT group and 12.7 months in the SRS group. There was no statistical difference between two groups (P=0.129). Multivariate analysis showed that the main factors leading to poor prognosis included the number of tumors of >3(P=0.026), low GPA score (P=0.035), and lack of systematic treatment mode and bevacizumab (P=0.001). There was no statistical difference in the incidence of acute and late radiation-induced brain injury between two groups. Conclusions Both SRT and SRS are effective therapies for brain metastases from colorectal cancer. The synergistic application of systematic treatment mode may be one of the main reasons affecting the survival time of the patients.
Pan Mianshun,WangMeng,Li Yong et al. Single-fraction SRS and multi-fraction SRT for brain metastases from colorectal cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(4): 347-351.
Pan Mianshun,WangMeng,Li Yong et al. Single-fraction SRS and multi-fraction SRT for brain metastases from colorectal cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(4): 347-351.
[1] Müller S, Köhler F, Hendricks A, et al. Brain metastases from colorectal cancer:A systematic review of the literature and meta-analysis to establish a guideline for daily treatment[J]. Cancers (Basel), 2021, 13(4) DOI:10.3390/cancers13040900.
[2] McGovern K, Smith MH, Maloney A, et al. Is there an ethnic predisposition to developing brain metastases (bm) in asian patients with colorectal cancer?[J]. Cancer Med J, 2021, 4(1):12-15.
[3] 梁晓华. 结直肠癌脑转移的临床特征及其治疗[J]. 上海医药, 2016, 37(23):12-14,31. DOI:10.3969/j.issn.1006-1533.2016.23.004.
Liang XH. The clinical characteristic and treatment of brain metastases from colorectal cancer. Shanghai Pharmaceutical.2016, 37(23):12-14. DOI:10.3969/j.issn.1006-1533.2016.23.004.
[4] Lehrer EJ, Peterson JL, Zaorsky NG, et al. Single versus multifraction stereotactic radiosurgery for large brain metastases:an international meta-analysis of 24 trials[J]. Int J Radiat Oncol Biol Phys, 2019,103(3):618-630. DOI:10.1016/j.ijrobp.2018.10.038.
[5] 潘绵顺, 李勇, 邱书珺, 等. SRT联合贝伐珠单抗治疗肺腺癌脑转移瘤的疗效评估[J]. 中华放射肿瘤学杂志, 2017, 26(8):880-883. DOI:10.3760/cma.j.issn.1004-4221.2017.08.007.
Pan MS, Li Y, Qiu SJ, et al. Efficacy and safety of stereotactic radiotherapy combined with bevacizumab for brain metastases of lung adenocarcinoma[J]. Chin J Radiat Oncol,2017,26(8):880-883. DOI:10.3760/cma.j.issn.1004-4221.2017.08.007.
[6] 李勇, 刘风华, 梁康宁, 等. SRT与SRS治疗肺腺癌脑转移瘤对比分析[J]. 中华放射肿瘤学杂志, 2020, 29(2):88-92. DOI:10.3760/cma.j.issn.1004-4221.2020.02.002.
Li Y, Liu FH, Liang KN,et al. A comparative analysis of SRT and SRS in the treatment of brain metastases from lung adenocarcinoma[J]. Chin J Radiat Oncol,2020, 29(2):88-92. DOI:10.3760/cma.j.issn.1004-4221.2020.02.002.
[7] 潘绵顺,李勇,邱书珺,等. 贝伐单抗治疗放射性脑坏死初步疗效分析[J]. 中华放射肿瘤学杂志, 2015, 24(4):434-437. DOI:10.3760/j.issn.1004-4221.2015.04.028.
Pan MS, Li Y, Qiu SJ, et al. Preliminary efficacy of bevacizumab for cerebral radiation necrosis[J]. Chin J Radiat Oncol,2015,24(4):434-437. DOI:10.3760/j.issn.1004-4221.2015.04.028.
[8] Navarria P, Minniti G, Clerici E, et al. Brain metastases from primary colorectal cancer:is radiosurgery an effective treatment approach? Results of a multicenter study of the radiation and clinical oncology Italian association (AIRO)[J]. Br J Radiol,2020, 93(1116):20200951. DOI::10.1259/bjr.20200951.
[9] Qin H, Wang C, Jiang Y, et al. Patients with single brain metastasis from non-small cell lung cancer equally benefit from stereotactic radiosurgery and surgery:a systematic review[J]. Med Sci Monit, 2015, 21:144-152. DOI:10.12659/MSM.892405.
[10] Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs. stereotactic radiosurgery alone for treatment of brain metastases:a randomized controlled trial[J]. JAMA, 2006, 295(21):2483-2491. DOI:10.1001/jama.295.21.2483.
[11] Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases:results of the EORTC 22952-26001 study[J]. J Clin Oncol, 2011, 29(2):134-141. DOI:10.1200/JCO.2010.30.1655.
[12] Gu XD, Cai YT, Zhou YM, et al. Prognostic factors and multidisciplinary treatment modalities for brain metastases from colorectal cancer:analysis of 93 patients[J]. BMC Cancer, 2015, 15:902. DOI:10.1186/s12885-015-1933-2.
[13] 初曙光,杨长蔚,梁晓华,等. 重视脑转移瘤标准化影像检查以提高影像评估准确性[J]. 中华转移性肿瘤杂志,2021,04(1):10-14. DOI:10.3760/cma.j.cn101548-20201111-00170.
Chu SG, Yang CW, Liang XH, et al. Pay attention to standardized imaging examination of brain metastases to improve the accuracy of imaging evaluation[J]. Chin J Meta Cancer,2021,04(1):10-14. DOI:10.3760/cma.j.cn101548-20201111-00170.
[14] Sun J, Wang C, Zhang Y, et al. Genomic signatures reveal DNA damage response deficiency in colorectal cancer brain metastases[J]. Nat Commun, 2019, 10(1):3190. DOI:10.1038/s41467-019-10987-3.
[15] Roussille P, Tachon G, Villalva C, et al. Pathological and molecular characteristics of colorectal cancer with brain metastases[J]. Cancers (Basel), 2018, 10(12):504. DOI:10.3390/cancers10120504.