Vol 9: Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1-3 cerebral metastases.Reportar como inadecuado



 Vol 9: Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1-3 cerebral metastases.


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This article is from Radiation Oncology London, England, volume 9.AbstractBackground: In the present study factors affecting survival and toxicity in cerebral metastasized patients treated with stereotactic radiosurgery SRS were analyzed with special focus on radiation necrosis. Patients and methods: 340 patients with 1–3 cerebral metastases having been treated with SRS were retrospectively analyzed. Radiation necrosis was diagnosed by MRI und PET imaging. Univariate and multivariate analysis using a Cox proportional hazards regression model and log-rank test were performed to determine the prognostic value of treatment-related and individual factors for outcome and SRS-related complications. Results: Median overall survival was 282 days and median follow-up 721 days. 44% of patients received WBRT during the course of disease. Concerning univariate analysis a significant difference in overall survival was found for Karnofsky Performance Status KPS ≤ 70: 122 days; KPS  70: 342 days, for RPA recursive partitioning analysis class RPA class I: 1800 days; RPA class II: 281 days; RPA class III: 130 days, irradiated volume ≤2.5 ml: 354 days; 2.5 ml: 234 days, prescribed dose ≤18 Gy: 235 days; 18 Gy: 351 days, gender male: 235 days; female: 327 days and whole brain radiotherapy +WBRT: 341 days-WBRT: 231 days. In multivariate analysis significance was confirmed for KPS, RPA class and gender. MRI and clinical symptoms suggested radiation necrosis in 21 patients after SRS +-− whole brain radiotherapy WBRT. In five patients clinically relevant radiation necrosis was confirmed by PET imaging. Conclusions: SRS alone or in combination with WBRT represents a feasible option as initial treatment for patients with brain metastases; however a significant subset of patients may develop neurological complications. Performance status, RPA class and gender were identified to predict improved survival in cerebral metastasized patients.



Autor: Schuttrumpf, Lars Hendrik; Niyazi, Maximilian; Nachbichler, Silke Birgit; Manapov, Farkhad; Jansen, Nathalie; Siefert, Axel; Belka, Claus

Fuente: https://archive.org/







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