脑转移瘤术前放射手术（PREOP-1）：可行性试验

IF 2.7 3区医学 Q3 ONCOLOGY Clinical and Translational Radiation Oncology Pub Date : 2024-06-01 DOI:10.1016/j.ctro.2024.100798

S Rogers , L Schwyzer , N Lomax , S Alonso , T Lazeroms , S Gomez , K Diahovets , I Fischer , S Schwenne , A Ademaj , S Berkmann , A Tortora , S Marbacher , L Remonda , G.A. Schubert , O Riesterer

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摘要

目的脑转移瘤（BM）术前放射外科（SRS）旨在实现腔隙局部控制，减少脑转移瘤复发（LMD），与术后SRS相比，不产生额外的放射性坏死。我们介绍了在神经外科手术切除脑转移瘤之前进行基于线性加速器的立体定向放射外科手术（SRS）的前瞻性可行性试验（PREOP-1）的最终结果。主要终点是在预计的肿瘤大体切除术前对所有患者进行基于线性加速器的术前 SRS 的可行性。次要终点包括LMD率、局部控制率和总生存率。探索性终点是免疫和增殖标志物的表达水平。结果招募了13名患者，中位年龄为65岁（41-77岁）。12名患者（92%）在术前接受了放射外科手术和转移灶切除术，1名患者直接进行了手术，并在术后接受了SRS治疗，因此未达到主要终点。从转诊到进行术前 SRS 的中位时间为 6.5 个工作日（1-10 天），从 SRS 到神经外科手术的中位时间为 1 天（0-5 天）。中位处方剂量为 16 Gy（14-19），中位计划目标体积为 12.7 cm3（5.9-26.1）。5名患者在术前SRS治疗后完成了为期12个月的随访，没有出现局部复发或脑室疾病。一名术后接受 FSRT 的患者在 6 个月后出现了 LMD。有一名患者出现一过性毒性（二级脱发），九名患者死于颅外原因。6 个月后，患者的运动无力症状明显改善（P = 0.04）。结论在大面积脑转移且无颅内压升高的患者中，12/13 的患者可行基于直流电的术前 SRS，12/12 的患者安全且无手术延迟或颅内并发症。

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Preoperative radiosurgery for brain metastases (PREOP-1): A feasibility trial

Purpose

Preoperative radiosurgery (SRS) of brain metastases (BM) aims to achieve cavity local control with a reduction in leptomeningeal relapse (LMD) and without additional radionecrosis compared to postoperative SRS. We present the final results of a prospective feasibility trial of linac-based stereotactic radiosurgery (SRS) prior to neurosurgical resection of a brain metastasis (PREOP-1).

Methods

Eligibility criteria included a BM up to 4 cm in diameter for elective resection. The primary endpoint was the feasibility of delivering linac-based preoperative SRS in all patients prior to anticipated gross tumour resection. Secondary endpoints included rates of LMD, local control and overall survival. Exploratory endpoints were the level of expression of immunological and proliferative markers.

Results

Thirteen patients of median age 65 years (range 41–77) were recruited. Twelve patients (92 %) received preoperative radiosurgery and metastasectomy and one patient went directly to surgery and received postoperative SRS, thus the primary endpoint was not met. The median time between referral and preoperative SRS was 6.5 working days (1–10) and from SRS to neurosurgery was 1 day (0–5). The median prescribed dose was 16 Gy (14–19) to a median planning target volume of 12.7 cm³ (5.9–26.1). Five patients completed 12-month follow-up after preoperative SRS without local recurrence or leptomeningeal disease. The patient who received postoperative FSRT developed LMD after six months. There was one transient toxicity (grade 2 alopecia) and nine patients have died from extracranial causes. Patients reported significant improvement in motor weakness at 6 months (P = 0.04). No pattern in changes of marker expression was observed.

Conclusion

In patients with large brain metastasis without raised intracranial pressure, linac-based preoperative SRS was feasible in 12/13 patients and safe in 12/12 patients without any surgical delay or intracranial complications.

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