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? 多發(fā)腦轉(zhuǎn)移灶潛在復(fù)發(fā) 合并 WBRT的理由 立體定向治療 ? 立體定向放療和全腦照射的聯(lián)合應(yīng)用仍在進一步研究中 ? Kondziolka等及 Pirzkall等認為 SRS的劑量應(yīng)達 15或 16Gy后,聯(lián)合全腦放射 ,1ys6080% 立體定向治療 ? 70例單發(fā)腦轉(zhuǎn)移, WBRT, SRS ,WBRT+SRS , 3組結(jié)果: SRS and WBRT+SRS 比 WBRT生存期長。 WBRT+SRS比 WBRTnew m 時間間隔延長 INT J Cancer, 2022, 90( 1) author Local control % Median survival %receiving WBRT Patients/metastasses, n SRS Surg SRS Surg SRS Surg SRS Surg Schoggl 95 83 12 9 100 100 67/67 66/66 bindal 61 92 71 66 31/NR 62/NR O’Neil 100 42 56%(1 y) 62%(1 y) 96 82 23/23 74/74 Patchell,1990 80 10 100 25/25 Patchell,1998 90 12 49/49 Noordijk NR 10 100 32/32 Tabl. Comparison of survival and local control using Surg versus SRS in select trials(1) author Local control % Median survival %receiving WBRT Patients/metastasses, n SRS Surg SRS Surg SRS Surg SRS Surg Mintz NR 6 100 41/41 Joseph 94 7 83 120/180 Kondziolka 92 11 100 13/NR Alexander 89 100 248/421 Flickinger 85 11 56 116/116 Andrews 82(1y) 100 75/NR Tabl. Comparison of survival and local control using Surg versus SRS in select trials(2) varial WBRT WBRT+SRS P value MS,mo MS single metastasis, mo MS RPA class I,mo 11. 6 MS squamous or NSCLC history,mo Stable KPS at 6 mo, % 27 43 rate of neurologic death,% 31 28 NS Local control of treated lesions at 1 y,% 71 82 Grade 3 acute toxicity,% 0 2 NS Grade 4 acute toxicity,% 0 1 NS Grade 3 late toxicity,% 2 3 NS Grade 4 late toxicity,% 1 3 NS Table. Results of the RTOG 9508 randomized trial of WBRT or without SRS in patient with 1 to 3 brain metastases author n Median survival ,mo Local control,% WBRT yes No yes No yes No Chidel,2022 58 78 + 80 52(2y) + Sneed,2022 301 268 NR NR Sneed,1999 43 62 79 71(1y) Pirzkall 78 158 92 Chitapanarux 0 41 NA 10 NA 76 NA:not applicable。 NR:not reported。 +:p Table. SRS with or without WBRT author Intracranial control % Elsewhere brain recurrence % Required salvage therapy % Required WBRT for salvage % WBRT yes No yes No yes No no Chidel,2022 60(2y) 34 + (2y) 26 52+ NR NR NR Sneed,2022 NR NR NR NR 7 37 24 Sneed,1999 63 42+ 28 50+ 19 40+ 26 Pirzkall NR NR NR NR NR NR NR Chitapanarux NA 33(1y) NA NR NA 51 29 Table. SRS with or without WBRT NA:not applicabl