立体定向放射外科治疗 1-10 例脑转移瘤,避免全脑放疗--CYBER-SPACE 随机 2 期试验结果。

IF 16.4 1区 医学 Q1 CLINICAL NEUROLOGY Neuro-oncology Pub Date : 2024-09-28 DOI:10.1093/neuonc/noae201
Rami A El Shafie, Denise Bernhardt, Thomas Welzel, Annabella Schiele, Daniela Schmitt, Paul Thalmann, Sinem Erdem, Angela Paul, Simon Höne, Kristin Lang, Laila König, Fabian Weykamp, Sebastian Adeberg, Adriane Lentz-Hommertgen, Cornelia Jäkel, Farastuk Bozorgmehr, Ursula Nestle, Michael Thomas, Anja Sander, Meinhard Kieser, Jürgen Debus, Stefan Rieken
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引用次数: 0

摘要

背景:立体定向放射外科(SRS)是治疗多发性脑转移瘤(BM)的一种新兴的全脑放疗(WBRT)替代疗法,可降低毒性并改善肿瘤控制。CYBER-SPACE试验比较了基于SPACE或MPRAGE MRI序列的SRS,以避免或推迟1-10例脑转移瘤患者的WBRT:根据SPACE或MPRAGE MRI序列对所有病灶进行SRS治疗。如果随后出现新的骨髓瘤,则重复进行 SRS。如果出现>10个新的BM、钩端膜疾病或SRS耐受性衰竭,则需要进行WBRT治疗。主要结果是无WBRT指征(WBRTi)。次要结果包括总生存期(OS)、安全性和生活质量。总生存率为77.1%(95%-CI:69.5%-83.1%),SPACE为78.5%(95%-CI:66.7%-86.5%),MPRAGE为76.0%(95%-CI:65.2%-83.9%)(HR=0.84,95%-CI:0.43-1.63,P=0.590)。有5-10个BM的患者无WBRTi生存期较短(HR=3.13,95%-CI:1.53-6.40,p=0.002)。总的中位OS为13.1个月,SPACE为10.5个月,MPRAGE为15.2个月(HR=1.10,95%-CI:0.78-1.56,P=0.585)。神经系统死亡率为10.1%。延长OS的预测因素包括Karnofsky表现状态>80%(HR=0.51,95%-CI:0.33-0.77,p=0.002)和同时接受免疫治疗(HR=0.34,95%-CI:0.23-0.52,p结论:与MPRAGE相比,灵敏度更高的SPACE序列并未改善疗效。对新病灶进行全面监测和立即再治疗的 SRS 可减少对 WBRT 的需求,并实现较低的神经系统死亡率。对于 1-10 个 BM 的患者,SRS 应被视为 WBRT 的有利替代方案。
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Stereotactic Radiosurgery for 1-10 Brain Metastases to avoid Whole-Brain Radiotherapy - Results of the CYBER-SPACE Randomized Phase 2 Trial.

Background: Stereotactic Radiosurgery (SRS) is an emerging alternative to whole-brain radiotherapy (WBRT) for treating multiple brain metastases (BM), reducing toxicity and improving tumor control. The CYBER-SPACE trial compared SRS based on either SPACE or MPRAGE MRI sequence for avoiding or delaying WBRT in patients with 1-10 BM.

Methods: Patients with 1-10 untreated BM were randomized 1:1 to receive SRS of all lesions based on either SPACE or MPRAGE MRI sequences. If subsequently new BM occurred, SRS was repeated. WBRT was indicated upon occurrence of >10 new BM, leptomeningeal disease or exhausted SRS-radiotolerance. The primary outcome was freedom from WBRT indication (WBRTi). Secondary outcomes included overall survival (OS), safety, and quality of life.

Results: 202 patients were randomized; SPACE n=99, MPRAGE n=103. 12-month WBRTi-free survival was 77.1% (95%-CI: 69.5%-83.1%) overall, 78.5% (95%-CI: 66.7%-86.5%) for SPACE, and 76.0% (95%-CI: 65.2%-83.9%) for MPRAGE (HR=0.84, 95%-CI: 0.43-1.63, p=0.590). Patients with 5-10 BM had shorter WBRTi-free survival (HR=3.13, 95%-CI: 1.53-6.40, p=0.002). Median OS was 13.1 months overall, 10.5 months for SPACE, and 15.2 months for MPRAGE (HR=1.10, 95%-CI: 0.78-1.56, p=0.585). Neurologic death rate was 10.1%. Predictors for longer OS included Karnofsky Performance Status >80% (HR=0.51, 95%-CI: 0.33-0.77, p=0.002) and concurrent immunotherapy (HR=0.34, 95%-CI: 0.23-0.52, p<0.001).

Conclusions: The more sensitive SPACE sequence did not improve outcomes over MPRAGE. SRS with thorough monitoring and immediate re-treatment for new lesions decreases the need for WBRT and achieves low neurologic death rates. SRS should be considered a favorable alternative to WBRT for patients with 1-10 BM.

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来源期刊
Neuro-oncology
Neuro-oncology 医学-临床神经学
CiteScore
27.20
自引率
6.30%
发文量
1434
审稿时长
3-8 weeks
期刊介绍: Neuro-Oncology, the official journal of the Society for Neuro-Oncology, has been published monthly since January 2010. Affiliated with the Japan Society for Neuro-Oncology and the European Association of Neuro-Oncology, it is a global leader in the field. The journal is committed to swiftly disseminating high-quality information across all areas of neuro-oncology. It features peer-reviewed articles, reviews, symposia on various topics, abstracts from annual meetings, and updates from neuro-oncology societies worldwide.
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