| Title: | Reduced-dose WBRT combined with SRS for 1-4 brain metastases aiming at minimizing neurocognitive function deterioration without compromising brain tumor control |
| Authors: | Nakano, Toshimichi Browse this author |
| Aoyama, Hidefumi Browse this author →KAKEN DB |
| Onodera, Shunsuke Browse this author |
| Igaki, Hiroshi Browse this author |
| Matsumoto, Yasuo Browse this author |
| Kanemoto, Ayae Browse this author |
| Shimamoto, Shigetoshi Browse this author |
| Matsuo, Masayuki Browse this author |
| Tanaka, Hidekazu Browse this author |
| Oya, Natsuo Browse this author |
| Matsuyama, Tomohiko Browse this author |
| Ohta, Atsushi Browse this author |
| Maruyama, Katsuya Browse this author |
| Tanaka, Takahiro Browse this author |
| Kitamura, Nobutaka Browse this author |
| Akazawa, Kohei Browse this author |
| Maebayashi, Katsuya Browse this author |
| Keywords: | Brain metastases |
| Cognition |
| Recurrence |
| Radiation |
| Whole brain |
| Stereotactic radiosurgery |
| Issue Date: | Nov-2022 |
| Publisher: | Elsevier |
| Journal Title: | Clinical and Translational Radiation Oncology |
| Volume: | 37 |
| Start Page: | 116 |
| End Page: | 129 |
| Publisher DOI: | 10.1016/j.ctro.2022.09.005 |
| Abstract: | Background and purpose: To minimize cognitive decline without increasing brain tumor recurrence (BTR) by reduced-dose whole-brain radiotherapy (RD-WBRT) (25 Gy, 10 fractions) + stereotactic radiosurgery (SRS) in patients with <= 4 brain metastases.Materials and methods: Eligible patients with <= 4 brain metastases on contrast-enhanced MRI and Karnofsky Performance Status >= 70. The primary endpoint was the non-inferiority of BTR at distant sites in the brain (BTR-distant)-free survival at 6 months compared to that of the standard dose (SD)-WBRT (30 Gy, 10 fractions) + SRS arm in a randomized clinical trial (JROSG99-1) of SRS with/without SD-WBRT. Secondary endpoints included BTR at any brain sites (BTR-all) and neurocognitive function assessed by a six-test standardized battery.Results: Forty patients from seven institutions were enrolled (median age 69 years). The primary tumor site was a lung in 28 patients; 20 patients had a solitary brain metastasis. The median survival time was 19.0 months (95 % CI: 13.8 %-27.5 %). The BTR-distant-free survival at 6 months was 76.9 % (59.5 %-87.7 %), which is compa-rable to that of historical control although predetermined non-inferiority (>71 %) could not be confirmed (p = 0.16). The cumulative incidence of BTR-all at 6 months accounting for the competing risk of death was 23.0 % (11.4-37.1), which was not worse than that of historical control (p = 0.774). The frequency of the cumulative incidence of persistent cognitive decline at 6 months was 48.6 % under the [>2.0 SD in >= 1 test] definition.Conclusions: RD-WBRT may yield comparable intracranial tumor control when combined with SRS, and may reduce the risk of neurocognitive decline compared to that after SD-WBRT. |
| Type: | article |
| URI: | http://hdl.handle.net/2115/87650 |
| Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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