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Cancer radiothérapie : journal de la Société française de radiothérapie oncologique v.21 no.8, 2017년, pp.731 - 740   SCIE
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Hypofractionated stereotactic radiotherapy for brain metastasis: Benefit of additional whole brain radiotherapy?
RadiothErapie stErEotaxique hypofractionnEe des mEtastases cErEbrales : bEnEfice de l'irradiation encEphalique totale ?

Royer, P. (Département universitaire de radiothérapie–curiethérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France ) ; Salleron, J. (Cellule <i>datamanagement</i>et biostatistiques, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France ) ; Vogin, G. (Département universitaire de radiothérapie–curiethérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France ) ; Taillandier, L. (Service de neurologie, université ) ; Clément-Duchêne, C. (de Lorraine, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO 60034, 54035 Nancy, France ) ; Klein, O. (Département universitaire d'oncologie médicale, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France ) ; Faivre, J.-C. (Service de neurochirurgie pédiatrique ) ; Peiffert, D. ; Bernier, V. ;
  • 초록  

    Abstract Purpose To study overall survival, risk of neurological death, local recurrence and development of new brain metastasis in patients treated for brain oligometastases with hypofractionated stereotactic radiotherapy with CyberKnife ? , according to the association or not with an additional whole brain irradiation. Patients and methods Institutional retrospective study of 102 patients treated for one to three brain metastasis: 76 with exclusive hypofractionated stereotactic radiotherapy and 26 with hypofractionated stereotactic radiotherapy and whole brain irradiation. Objectives were assessed and compared between these two groups according to the Kaplan–Meier method and Cox model. Results Median follow-up was 18.8 months. There were no difference between exclusive hypofractionated stereotactic radiotherapy and hypofractionated stereotactic radiotherapy with whole brain irradiation for overall survival (respective median 21.5 and 20.1 months), risk of neurological death (respectively 9.2% and 15.4% at one year). At one year: the risk of cerebral progressive disease was greater in the group receiving exclusive hypofractionated stereotactic radiotherapy (respectively 43.4% vs. 26.2%, P = 0.043), the risk of local recurrence was 25% versus 17.6% ( P = 0.28) and the development of new brain metastasis was 23.7% versus 11.5% ( P = 0.27). After salvage treatments, crude local control was similar in the two groups, respectively 78.6% and 73.5%. Whole brain irradiation has been avoided for 72.4% of patients in the group receving exclusive hypofractionated stereotactic radiotherapy. Conclusion Whole brain irradiation improves local control of brain metastatic disease in addition to hypofractionated stereotactic radiotherapy. Sparing whole brain irradiation for salvage treatments only does not affect overall survival or risk of neurological death in selected patients with favourable prognosis.


    REsumE Objectifs Etude de la survie globale, du risque de dEcEs neurologique, de la progression locale et de l’apparition de nouvelles mEtastases cErEbrales chez des patients pris en charge pour des oligomEtastases cErEbrales par irradiation stErEotaxique hypofractionnEe par CyberKnife ? , selon l’association ou non A une irradiation encEphalique totale complEmentaire. Patients et mEthodes Etude rEtrospective institutionnelle sur 102 patients pris en charge pour une A trois mEtastases cErEbrales : 76 par irradiation stErEotaxique hypofractionnEe exclusive et 26 par irradiation stErEotaxique hypofractionnEe et irradiation encEphalique totale. Les objectifs ont EtE EvaluEs et comparEs entre ces deux groupes selon la mEthode de Kaplan–Meier et le modEle de Cox. REsultats Le suivi mEdian Etait de 18,8 mois. Il n’y avait pas de diffErence entre les groupes traitEs par irradiation stErEotaxique hypofractionnEe exclusive et ceux traitEs par irradiation stErEotaxique hypofractionnEe et irradiation encEphalique totale en termes de survie globale (mEdianes respectives de 21,5 mois et 20,1 mois), ni de risque de dEcEs neurologique (9,2 % et 15,4 % A un an). Le risque de progression cErEbrale A un an Etait plus important dans le groupe traitE par irradiation stErEotaxique hypofractionnEe exclusive (43,4 % contre 26,2 %, p = 0,043), avec un risque de progression locale de 25 % contre 17,6 % ( p = 0,28) et d’apparition de nouvelles mEtastases cErEbrales de 23,7 % contre 11,5 % ( p = 0,28). AprEs traitements de rattrapage, le taux de contrOle local brut Etait identique entre les deux groupes, respectivement 78,6 % et 73,5 %. La radiothErapie encEphalique totale a pu Etre EvitEe pour 72,4 % des patients du groupe traitE par irradiation stErEotaxique hypofractionnEe exclusive. Conclusion L’irradiation encEphalique totale amEliore le taux de contrOle local de la maladie mEtastatique cErEbrale en complEment de l’irradiation stErEotaxique hypofractionnEe. Ne pas la rEaliser d’emblEe pour la rEserver aux seuls traitements de rattrapage n’altEre ni la survie globale ni le risque de dEcEs neurologique chez les patients sElectionnEs, atteints de cancer de pronostic favorable.


  • 주제어

    Métastase cérébrale .   Radiothérapie stéréotaxique .   CyberKnife® .   Irradiation encéphalique totale .   Brain metastasis .   Stereotactic radiotherapy .   CyberKnife® .   Whole brain radiotherapy.  

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