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Reduced-dose WBRT combined with SRS for 1-4 brain metastases aiming at minimizing neurocognitive function deterioration without compromising brain tumor control

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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
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
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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