评估接受脑转移系统治疗的患者的现实监测策略
Assessment of real-world surveillance strategies for patients undergoing systemic therapy for brain metastases.
摘要(中文译文)
放疗长期以来一直是脑转移的一线治疗。然而，中枢神经系统穿透性全身治疗正日益被用作一线替代方案。在此背景下，指导监测的证据很少。本研究回顾性评估了单中心的监测策略及相关结局。回顾了2021年至2024年期间接受评估并仅接受全身治疗的活动性脑转移患者的33份病历。评估了从诊断至第1次、第2次和第3次监测MRI的时间、颅内进展发生率、生存期及神经系统不良事件。根据治疗是否得到2021年ASCO-SNO-ASTRO指南的支持对患者进行分层。14/33例患者的治疗符合指南。至第1次、第2次和第3次MRI的中位（范围）时间分别为45（18-207）、95（46-204）和180（74-329）天。指南组1年局部进展累积发生率为0.43（95% CI [0.18-0.66]），非指南组为0.32（95% CI [0.13-0.52]，p=0.5）。指南组1年脑部放疗累积发生率为0.29（95% CI [0.09-0.53]），非指南组为0.44（95% CI [0.22-0.64]，p=0.87）。2例患者在全身治疗期间发生安全性事件（癫痫发作）。在本研究中，使用中枢神经系统穿透性全身治疗脑转移已超出国家指南的推荐范围。尽管监测影像学频率不一且复发常见，但许多患者能够将放疗延迟一年以上，且安全性事件不常见。随着对中枢神经系统穿透性全身治疗的关注和选择不断增加，基于证据的监测指南将势在必行。
Abstract
Radiotherapy has long been first-line treatment for brain metastases. However, CNS penetrating systemic therapies are increasingly used as first-line alternatives. There is little evidence guiding surveillance in this setting. Here we retrospectively assessed surveillance strategies at a single institution and associated outcomes. Records from 33 patients, evaluated from 2021-2024 and treated with systemic therapy alone for active brain metastases, were reviewed. Time from diagnosis to 1st, 2nd, and 3rd surveillance MRI, incidence of intracranial progression, survival, and neurological adverse events were assessed. Patients were stratified by whether treatment was supported by the 2021 ASCO-SNO-ASTRO guidelines. Treatment met guidelines for 14/33 patients. Median (range) time to 1st, 2nd, and 3rd MRI was 45 (18-207), 95 (46-204), and 180 (74-329) days, respectively. One-year cumulative incidence of local progression in the guideline group was 0.43 (95% CI [0.18-0.66]) and in the non-guideline group was 0.32 (95% CI [0.13-0.52], p=0.5). One-year cumulative incidence of brain radiation in the guideline group was 0.29 (95% CI [0.09-0.53]) and in the non-guideline group was 0.44 (95% CI [0.22-0.64], p=0.87). Two patients experienced safety events on systemic therapy (seizures). Use of CNS-penetrating systemic therapies to treat brain metastases outpaced national guidelines in this study. While surveillance imaging frequency was variable and recurrences were common, many patients were able to delay radiation for over one year, with infrequent safety events. As interest in and options for CNS-penetrating systemic therapy grow, evidence-based guidelines for surveillance will be warranted.
如何引用
AMA
Britney Weng, Caressa Hui, Jerica Lomax, Ahmed Mohyeldin, Nataliya Mar, Warren A Chow, et al. Assessment of real-world surveillance strategies for patients undergoing systemic therapy for brain metastases.. Frontiers in oncology. 2026; doi:10.3389/fonc.2026.1815993.
APA
Britney Weng, Caressa Hui, Jerica Lomax, Ahmed Mohyeldin, Nataliya Mar, Warren A Chow, et al (2026). Assessment of real-world surveillance strategies for patients undergoing systemic therapy for brain metastases.. Frontiers in oncology. https://doi.org/10.3389/fonc.2026.1815993
GB/T 7714
Britney Weng, Caressa Hui, Jerica Lomax, Ahmed Mohyeldin, Nataliya Mar, Warren A Chow, et al. Assessment of real-world surveillance strategies for patients undergoing systemic therapy for brain metastases.[J]. Frontiers in oncology, 2026 doi:10.3389/fonc.2026.1815993.
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