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Objective: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.
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The incidence rate of lung cancer ranks second and the mortality rate ranks first in the world. Non-small cell lung cancer (NSCLC) is the main pathological type and is prone to brain metastasis. At present, the main treatment methods of brain metastases from NSCLC include surgery, radiotherapy, chemotherapy, molecular targeting and immunotherapy. Radiotherapy is a common local treatment of brain metastases. With the development of technology and drugs, how to combine radiotherapy with other treatments is a hot topic in clinical research. In this article, advances in radiotherapy for brain metastases from NSCLC were reviewed, aiming to provide reference for the selection of treatment options in clinical practice.
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Objective To compare the efficacy and safety between whole brain radiotherapy (WBRT) and WBRT combined with temozolomide (TMZ) in the treatment of non-small cell lung cancer with brain metastases.Methods According to the retrieval strategy,the Chinese and English literatures before February 2018 were retrieved from EMbase,Cochrane,PubMed,Wanfang database,Chongqing VIP and CNKI,The target literatures were selected according to the inclusion and exclusion criteria,The quality of the included studies and extracted data was independently assessed by 3 researchers,The RevMan 5,3 and STATA 12,0 software was used for statistical analysis,The objective remission rate (ORR),the total survival period (OS),the progression-free survival (PFS),and the side effects of chemotherapy were evaluated.Results In total,17 trials consisting of 1128 patients were included,The results of Meta-analysis demonstrated that compared with the WBRT group,the ORR was significantly higher (OR=2.54;95％CI:1.93-3.36;P＜0.001),the PFS was significantly longer (MS R=1.329;95％CI:1.143-1.545;P＜0,001),and the incidence of hematological toxicity (OR=3.44;95％CI:1.63-7.26;P＜ 0.05) and the gastric intestinal reaction (OR=1.69;95％CI:1.24-2.31;P＜0.05) was significantly higher in the WBRT+TMZ group,The heterogeneities were within the acceptable range with statistical significance,The results of OS were invalid due to relatively large heterogeneity,The incidence of headache did not significantly differ between two groups (OR=1.05;95％CI:0.72-1.55;P=0,79).Conclusions Compared with WBRT alone,WBRT combined with TMZ is beneficial to improve the short-term efficacy,whereas the incidence of hematological toxicity and gastrointestinal reaction is higher,The occurrence of headache does not significantly differ between two groups,The benefit of long-term survival remains uncertain.
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Objective To evaluate the plan quality of volumetric modulated arc therapy (VMAT) in single brain metastasis compared with the stereotactic arc therapy (S_ARC).Methods 31 patients were replanned using VMAT and S_ARC technique.Prescription dose is 40 Gy delivered in 4 fractions covering at least 95％ of the target volume while keeping minimum doses to the volume of normal brain tissue.The plans were assessed and compared using the conformity indexes (CI),gradient indexes (GI),the mean dose of normal brain tissue,the volumes of normal brain tissue receiving 4 Gy doses,the number of monitor unit and treatment times.A paired t test or non-parametric Wilcoxon signed rank test was performed to analyze the difference between these two plans.Results VMAT plans increased dose conformity,but not dose gradient,compared with S_ARC plans.The median dose conformity index values were 0.815,0.818,and 0.779 (P =0.000,0.000),and the median dose gradient score index values were 5.865,5.706,and 3.133(P =0.000,0.000,0.000),in single arc,double arc VMAT plans and S_ARC plans,respectively.The mean dose of normal brain tissue was higher in VMAT plans.And the volume of the normal brain tissue receiving doses of 4 Gy in VMAT plans was significantly larger than the volume in S_ARC plans.The VMAT plans got higher MU number (P =0.000,0.000).And the mean treatment times were (2.7 ± 0.1) min,(2.8 ± 0.1) min,and (7.6 ± 0.2) min in single arc,double arc VMAT plans and S_ ARC plans,respectively (P =0.000,0.000).Conclusions The dosimetry of VMAT plan can meet the requirements of clinical,and is recommended in the treatment of big volume single brain metastasis or single brain metastasis in cerebellum.
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Objective To compare the efficacy between the brucea javanica oil emulsion combined with the whole radiotherapy group (treatment group) and only radiotherapy group (control group) in non-small cell lung cancer patients with brain metastases.Methods The clinical data of 53 non-small cell lung cancer patients with brain metastasis were retrospectively reviewed,including 27 cases in treatment group and 26 cases in control group.Results The remission rates were 77.8 ％ (21/27) and 69.2 ％ (18/26) respectively in treatment group and control group.The improvement rates of Kamofsky in the treatment group and control group were 66.7 ％ (18/27) and 30.8 ％ (8/26),the stable rates were 22.2 ％ (6/27) and 30.8 ％ (8/26),the decrease rates were 11.1％ (3/27) and 38.5 ％ (10/26).The remission rates of clinical sympotoms were 92.6 ％ (25/27) and 69.2 ％ (18/26) respectively in treatment group and control group.The difference of remission rate between two groups has no statistic significance (P ＞ 0.05),while the difference of the quality of life and clinical sympotoms between two groups were significant respectively (P ＜ 0.05).Conclusion The brucea javanica oil emulsion combined with the whole radiotherapy can relieve clinical sympotoms and improve the quality of life of patients,and may play a role on improving the effect of radiotherapy.
