小细胞肺癌PCI后脑转移的再程放疗

REPEAT WHOLE-BRAIN RADIOTHERAPY

Occasionally, patients fail in the brain with multiple lesions after

initial WBRT. Repeat WBRT should strongly be considered.

Wong et al. 27 reported on a series of 86 patients who underwent

repeat WBRT. The median dose for the first course was 30 Gy,

whereas the median dose for the second course was 20 Gy. A total

of 70% experienced neurologic improvement, with 27% experiencing

complete neurological resolution, whereas 43% had partial

improvement with repeat WBRT. Retreatment dose of 20

Gy was associated with a significantly longer survival. Only one

patient experienced dementia thought to be caused by radiation.

Repeat WBRT is relatively safe because most patients have

limited survival with recurrent or progressive brain metastases

after initial WBRT. A minimum of 20 in 1.8 to 2 Gy fractions

should be given.

谢谢 ta268战友最近分享的那本肺癌理论与实践（回复：【资料】ebook:Principles and Practice of Lung Cancer (4版) - 丁香园论坛）

随文附上相关的原始文献，发表于1986年红皮杂志。

加一篇更新一点的，发表与2007年clinical oncology

Value of whole brain re-irradiation for brain metastases--single centre experience.

Sadikov E , Bezjak A , Yi QL , Wells W , Dawson L , Millar BA , Laperriere N .

Source

Radiation Oncology Department, Allan Blair Cancer Centre, University of Saskatchewan, Regina, Canada.

Abstract

AIMS:

There is controversy in published studies regarding the role of repeat whole brain radiation (WBRT) for previously irradiated brain metastases. The aim of our retrospective study was to document the practice at Princess Margaret Hospital with respect to the re-irradiation of patients with progressive or recurrent brain metastatic disease after initial WBRT.

MATERIALS AND METHODS:

A comprehensive computerised database was used to identify patients treated for brainmetastases with more than one course of WBRT between 1997 and 2003. Seventy-two patients were treated with WBRT forbrain metastases and retreated with WBRT at a later date. The records of these patients were reviewed.

RESULTS:

The median age was 56.5 years. The most common primary sites were lung (51 patients) and breast (17 patients). The most frequent dose used for the initial radiotherapy was 20 Gy/5 fractions (62 patients). The most common doses of re-irradiation were 25 Gy/10 fractions (22 patients), 20 Gy/10 fractions (12 patients), 15 Gy/5 fractions (11 patients) and 20 Gy/8 fractions (10 patients). Thirty-one per cent of patients experienced a partial clinical response after re-irradiation, as judged by follow-up clinical notes; 27% remained stable; 32% deteriorated after re-irradiation. Patients who had Eastern Cooperative Oncology Group performance status 0-1 at the time of retreatment lived longer. In responders, the mean duration of response was 5.1 months. The median survival after re-irradiation was 4.1 months. One patient was reported as having memory impairment and pituitary insufficiency after 5 months of progression-free survival.

CONCLUSION:

Repeat radiotherapy may be a useful treatment in carefully selected patients. With increased survival and better systemic options for patients with metastatic disease, more patients may be candidates for consideration of repeat WBRT for recurrent brain metastases, but prospective studies are needed to more clearly document their outcomes.

PMID: 17662582 [PubMed - indexed for MEDLINE]