关键词: 大体积脑转移瘤, 立体定向放射外科, 分期治疗, 疗效及安全性

Abstract: Objective To investigate the efficacy,safety and prognostic factors of stereotactic radiosurgery staging for massive brain metastases.Methods The clinical data of 52 patients with massive brain metastases treated by stereotactic radiosurgery were collected.Two cycles of radiosurgery were given.The median peripheral dose of the first phase was 12Gy (10-13),the median treatment interval was 28 days (25-47 days),and the median peripheral dose of the second phase was 14Gy (12-15).After the second stage treatment,the short-term efficacy was evaluated by comparing the imaging data before and after treatment,and the long-term efficacy and safety were observed.Results The 3-month ORR was 46.2%,the 1-year LCR was 88.5%,the 6-month overall survival rate was 74.8%,the 1-year overall survival rate was 62.2%,the median OS was 11.25 months (3.15~15.3 months),and the PFS was 9.16 months (4.25~13.7 months).45 patients had obvious nervous system symptoms before treatment,42 patients (93.3%) had obvious improvement in clinical symptoms after treatment,and the median KPS score was increased from 60 to 80.After treatment,9 patients (17.3%) had grade 1-2 acute CNS radiotherapy side effects,and 1 patient (1.92%) had grade 3-4 acute CNS radiotherapy side effects,which were alleviated after symptomatic treatment.Conclusion Stereotactic radiosurgery in staging treatment of massive brain metastases has a high local tumor control rate,can reduce the intracranial tumor load in the shortest time,significantly improve the adverse symptoms of the nervous system,and improve the quality of life of patients.With fewer adverse reactions and high safety,it is one of the effective methods for local treatment of massive brain metastases.Tumor volume,tumor peripheral dose and tumor location were the factors influencing the local control rate of patients;The primary lesion was not controlled,GPA score,RPA grade and KPS score were the influencing factors for the survival of patients.

Key words: Large brain metastases, Stereotactic radiosurgery, Staged treatment, Efficacy and Safety