关于脑转放疗后进展的二次全脑放疗的文献介绍

jimmy112199

本文中介绍了脑转放疗后进展的二次全脑放疗得的方法及存活率结果。
方法：小剂量，每日两次，连续一段时间达到必要的全剂量。
存活率结果：
文献1：15人加入，中位存活率3。2个月，两人超过9个月。
文献2：86人加入，中位存活率4个月，最长72个月。
文献3：72人加入，中位存活率4。1个月。

Re-Irradiation of Brain Metastases                                                        
December 7, 2008 - 1:47                                                                                                                                                                                 Dr. Goldberg                                                                                                               
                Re-treatment of brain metastases is one of the most difficult of cancertreatment problems.  It is also an area where the art of medicinesupersedes the science by a long way.  The good news is that it islikely easier and safer as we shift from whole brain radiation therapy(WBRT) as standard for the first line treatment of brain metastases tostereotactic treatment (SRS).  The bad news is that our ability to lookto the medical literature for guidance of risks and benefits is less.
   There are some studies looking at re-irradiation of the whole brain using altered radiation fractionation schedules (abstract here)after patients received standard WBRT.  The rationale for that is thatthe brain is an example of a tissue that is very sensitive to the size of the radiation treatment fraction.  So, giving smaller doses (fewercentiGray or rads) with each treatment and then treating twice a day to get the necessary total dose in a reasonable time, is an approach with solid theoretical rationale.  The study linked above treated 15 patients and none had significant side effects while on treatment, but median survival was 3.2 months, with 2 longer term survivors, out past 9 months.  Sixty percent (9 patients) had improvement from there-irradiation.
   A larger, though older, study (abstract here)looked at re-irradiation using standard fraction size after WBRT firstline.  Median survival was 4 months, though the longest survival was 72months.  Of the 86 patients reported on in this study, twenty-threepatients (27%) had resolution of neurologic symptoms, 37 patients (43%)had partial improvement of neurologic symptoms, and 25 patients (29%)had either no change or worsened after re-irradiation.  Anotherretrospective study, this one from Princess Margaret Hospital inToronto, Canada (abstract here)of 72 patients showed similar outcomes, with median survival of 4.1months after re-irradiation.  Thirty-one percent responded, 27% werestable and 32% deteriorated post re-irradiation (though it is notstated if this is likely radiation or disease related, but clearly there-irradiation provided no benefit).  The similarity of the results isnoteworthy given that in Canada it is more common to use larger dosesper fraction of radiation and shorter courses of treatment than in theUS.  Therefore, it confirms for us that the effects from two courses ofwhole brain radiation are that roughly 1/3-2/3 of patients will benefit.
   What about re-treatment after stereotactic treatment front line? If the tumors are distant from each other, there is no difficulty orconcern on treating the new brain mets with radiosurgery, as that areaof the brain hasn’t received much or potentially any radiation dose sofar.  What if the tumors are close together or recurrent in the samearea?  Here the data are thin soup- ie, sketchy.  Data from the groupat the  University of Pittsburgh group (abstract here),which is one of the best and most experienced in the world, shows thatit can be safe even if in the same area, depending upon dose used andvolume treated, but keep in mind, most places do not have the expertisethat U. Pitt does.  Also, as the volume of retreatment increased, sodid the neurologic decline of the patient.
   More difficult still is the question of when to move fromrepeated stereotactic treatments to whole brain radiation therapy.  Forthat, there is no clear answer and falls very much under the rubric of“clinical judgment”.  In the ASTRO (American Society for TherapeuticRadiation and Oncology) abstract discussed in a previous posting,there are many patients who now never move from stereotactic to wholebrain treatment, despite repeated intracranial metastases.  Factors toconsider when deciding on whole brain vs. stereotactic re-treatment arehow many metastases, the overall functioning of the patient and thestatus of disease outside the skull.
   Having been involved in this forum with patients and theirfamilies, I would add that side effects from whole brain radiationtherapy can be more disabling than is often reported in the medicalliterature, and so it seems that we will likely continue to see aclinical practice shift away from this option as SRS permeates more ofthe local cancer treatment centers.  In my opinion, WBRT continues tohave a valuable role in cancer treatment, but at this point, in thesituation of recurrent brain metastases it is probably best suited forpatients with many (>4) brain mets, and/or limited survival, though,in the interest of full disclosure, many of my colleagues woulddisagree.  There is little consensus about “how many brain metastasesare too many” for SRS in actual clinical practice.

[ 本帖最后由 jimmy112199 于 2008-12-18 05:34 编辑 ]

jimmy112199

The Role of Hyperfractionated Re-irradiation in Metastatic Brain Disease: A Single Institutional Trial.

Articles
American Journal of Clinical Oncology. 20(2):158-160, April 1997.
Abdel-Wahab, May M. R. M.D., Ph.D.; Wolfson, Aaron H. M.D.; Raub, William MS.Ph.; Landy, Howard M.D.; Feun, Lynn M.D.; Sridhar, Kasi M.D.; Brandon, Alfred H. M.D.; Mahmood, Saleem M.D.; Markoe, Arnold M. M.D., Sc.D.

Abstract:
Progression of brain metastases after brain irradiation has prompted several studies on retreatment of the brain. Increased durations of survival and improved quality of life have been reported. Fifteen patients with previously treated brain metastases were entered into this pilot study between May 1990 and January 1994. All patients had neurologic and/or radiologic evidence of progression of brain metastases. The lung was the primary site in 60% of cases. The remaining 40% had breast, ovarian, and skin primaries. The median interval between the first treatment and retreatment was 10 months. All patients received whole-brain irradiation with or without a boost for their initial treatment course. Doses ranged from 3,000 to 5,500 cGy for initial treatments (median, 3,000). Retreatment consisted of limited fields with a median side equivalent square of 8.8 cm. Patients were retreated with a median dose of 3,000 cGy (range, 600-3,000 cGy). A median cumulative dose of 6,000 cGy was achieved. Retreatment consisted of twice-daily fractions (150 cGy/fraction). Retreatment was tolerated without serious complications. Of the 15 patients treated, nine (60%) experienced improvement, and five (27%) had stabilization of neurologic function and/or radiographic parameters. Median survival was 3.2 months; two of the reirradiated patients survived >=9 months. In conclusion, reirradiation is a viable option in patients with recurrent metastatic lesions of the brain, and the use of a limited retreatment volume makes this a well-tolerated, low-morbidity treatment that leads to clinical benefits and, in some instances, enhanced survival. The influence of hyperfractionation on the

jimmy112199

Analysis of outcome in patients reirradiated for brain metastases☆

William W. Wong, M.D.Corresponding Author Information∗email address, Steven E. Schild, M.D.∗, Timothy E. Sawyer, M.D.†, Edward G. Shaw, M.D.†3

Abstract

: Patients with newly diagnosed brain metastases generally benefit from whole brain radiation therapy (WBRT). However, the role of reirradiation for patients who develop progressive bain metastases has been controversial. This retrospective study examines our experience with reirradiation of patients for progressive brain metastases after an initial course of WBRT.

: From 1975–1993, 2658 patients received WBRT for brain metastases at our institution. Eighty-six patients were subsequently reirradiated for progressive brain metastases. The median age of these patients was 58 (range: 31–81). The most common primary sites were breast and lung. Fifty patients had metastatic disease at other sites. Most patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 2 (40 patients) or 3 (38 patients). The median dose of the first course of irradiation was 30 Gy (range: 1.5–50.6 Gy). The median dose of the second course of irradiation was 20 Gy (range: 8.0–30.6 Gy).

: Twenty-three patients (27%) had resolution of neurologic symptoms, 37 patients (43%) had partial improvement of neurologic symptoms, and 25 patients (29%) had either no change or worsened after reirradiation. The median survival following reirradiation was 4 months (range: 0.25–72 months). The majority of patients had no significant toxicity secondary to reirradiation. Five patients had radiographic abnormalities of their brain consistent with radiation-related changes. One patient had symptoms of dementia that was though to be caused by radiotherapy. Various potential prognostic factors were evaluated for possible associations with survival, including age, sex, primary site, ECOG performance status, RTOG neurologic functional class, absence of extracranial metastases, number of brain metastases, and dose of reirradiation. Absence of extracranial metastasis, solitary brain metastasis, and a retreatment dose > 20 Gy were associated with improved survival in univariate analysis (p = 0.025, 0.033, and 0.061, respectively). The absence of extracranial disease was the only significant factor in multivariate analysis (p = 0.05).

: The majority of patients in our series had favorable symptomatic responses. Clinically significant complications were minimal. Reirradiation should be offered to patients who develop progressive brain metastases.
Keywords:  Brain metastasis, Brain irradiation, Reirradiation

jimmy112199

Value of Whole Brain Re-irradiation for Brain Metastases — Single Centre Experience

E. Sadikov∗, A. Bezjak†Corresponding Author Informationemail address, Q.-L. Yi‡, W. Wells†, L. Dawson†, B.-A. Millar†, N. Laperriere†

Received 10 October 2006; received in revised form 9 May 2007; accepted 5 June 2007.
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 brain metastases with more than one course of WBRT between 1997 and 2003. Seventy-two patients were treated with WBRT for brain 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 20Gy/5 fractions (62 patients). The most common doses of re-irradiation were 25Gy/10 fractions (22 patients), 20Gy/10 fractions (12 patients), 15Gy/5 fractions (11 patients) and 20Gy/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.

testset

认真的阅读中

呢喃柠檬

Re-Irradiation of Brain Metastases
脑转移的再照射                                                      
December 7, 2008 - 1:47
2008年12月7日-1时4 7戈德堡博士                                               

  Re-treatment of brain metastases is one of the most difficult of

cancertreatment problems.  It is also an area where the art of medicine

supersedes the science by a long way.  The good news is that it is likely

easier and safer as we shift from whole brain radiation therapy(WBRT) as

standard for the first line treatment of brain metastases to stereo tactic

treatment (SRS).  The bad news is that our ability to look to the medical

literature for guidance of risks and benefits is less.
  再治疗脑转移瘤是最困难的癌症治疗问题之一。它也是一个领域，用药物大范围取代科

学的技术。好消息是，全脑放疗WBRT作为脑转移的一线标准治疗看起来比立体定向放射治

疗（SRS）要容易和安全些，。坏消息是，我们能看到的有关风险和受益的医学文献是很少

的。
   There are some studies looking at re-irradiation of the whole brain

using altered radiation fractionation schedules (abstract here)after

patients received standard WBRT.  The rationale for that is that the brain

is an example of a tissue that is very sensitive to the size of the

radiation treatment fraction.  So, giving smaller doses (fewer centiGray or

rads) with each treatment and then treating twice a day to get the

necessary total dose in a reasonable time, is an approach with solid

theoretical rationale.  The study linked above treated 15 patients and none

had significant side effects while on treatment, but median survival was

3.2 months, with 2 longer term survivors, out past 9 months.  Sixty percent

(9 patients) had improvement from there-irradiation.
   有一些研究，（这里做下摘要）旨在寻找病人接受过标准全脑放疗WBRT后的变化的照

射分流时间表，用于重复照射全脑。基本原理是大脑是一个对每个剂量放射治疗都非常敏

感的组织。因此，在每次治疗中给予小剂量（ 较少cgy厘戈瑞或拉德，1cgy厘戈瑞

=0.01gy戈瑞=1拉德），在合理的时间内每天两次，并获得必要的总剂量，这是一条符合

基本理论的途径。这项研究超过15个病人参与，并且没有任何一个人有重大的副作用，而

治疗，但中位生存期仅3.2个月， 只有2位幸存者超过9个月。60%（ 9例）在照射中得到

了改善。
A larger, though older, study (abstract here)looked at re-irradiation using

standard fraction size after WBRT firstline.  Median survival was 4 months,

though the longest survival was 72months.  Of the 86 patients reported on

in this study, twenty-three patients (27%) had resolution of neurologic

symptoms, 37 patients (43%)had partial improvement of neurologic symptoms,

and 25 patients (29%)had either no change or worsened after re-irradiation.

An other retrospective study, this one from Princess Margaret Hospital in

Toronto, Canada (abstract here)of 72 patients showed similar outcomes, with

median survival of 4.1months after re-irradiation.  Thirty-one percent

responded, 27% were stable and 32% deteriorated post re-irradiation (though

it is not stated if this is likely radiation or disease related, but

clearly there-irradiation provided no benefit).  The similarity of the

results isnoteworthy given that in Canada it is more common to use larger

dosesper fraction of radiation and shorter courses of treatment than in

theUS.  Therefore, it confirms for us that the effects from two courses

ofwhole brain radiation are that roughly 1/3-2/3 of patients will benefit.
   一个更大但早一点的研究（这里做下摘要），旨在寻找一线全脑放疗后的标准分流剂量

用于重新照射。中位生存4个月，但最长存活是72个月。参与这项研究的86例病人， 23例

（27%）解决了神经症状， 37例（ 43 ％ ）有部分改善神经症状， 25例（ 29 ％ ）在

重新照射后并没有改善或者受损。
   另一项回顾性的研究来自加拿大多伦多玛嘉烈医院（ 这里做下摘要），72例显示类似

的结果，重新照射后中位生存4.1月。31%做出响应， 27 ％ 稳定和32 ％重新照射后加速

恶化（虽然这不能确定是与辐射还是疾病有关，但清晰的是重复照射并没有好处） 。相似

的结果值得关注的是加拿大给出的例子是较常见的，即比起美国来说他们每次使用较大剂

量辐射和较短时间疗程治疗，因此，它向我们确定了全脑放射治疗的两种路线能使大约

1/3~2/3的病人受益。

   What about re-treatment after stereotactic treatment front line? If the

tumors are distant from each other, there is no difficulty orconcern on

treating the new brain mets with radiosurgery, as that areaof the brain

hasn’t received much or potentially any radiation dose sofar.  What if the

tumors are close together or recurrent in the samearea?  Here the data are

thin soup- ie, sketchy.  Data from the groupat the  University of

Pittsburgh group (abstract here),which is one of the best and most

experienced in the world, shows thatit can be safe even if in the same

area, depending upon dose used andvolume treated, but keep in mind, most

places do not have the expertisethat U. Pitt does.  Also, as the volume of

retreatment increased, sodid the neurologic decline of the patient.
  那么一线立体定向治疗后的重复照射呢？如果瘤体相隔很远，没有任何疑问，将放射治疗的关注重点放在治疗新的脑部转移病灶上。因为这区域的大脑还没有收到很多或潜在的任何辐射剂量 。如果肿瘤彼此间接近或在同一位置复发呢？这里的数据少得像稀汤而且还粗略。来自匹兹堡大学的研究小组的数据（ 这里做下摘要），这是当今世界最好的和最有经验的小组之一，显示即使是在同一个位置依靠剂量控制也能得到安全处理，但紧记，U. Pitt所做的大多数地方没有得到专家意见。此外，随着病人剂量的增大，神经认知能力也下降了。
   More difficult still is the question of when to move from repeated

stereotactic treatments to whole brain radiation therapy.  For that, there

is no clear answer and falls very much under the rubric of“clinical

judgment”.  In the ASTRO (American Society for TherapeuticRadiation and

Oncology) abstract discussed in a previous posting,there are many patients

who now never move from stereotactic to wholebrain treatment, despite

repeated intracranial metastases.  Factors toconsider when deciding on

whole brain vs. stereotactic re-treatment arehow many metastases, the

overall functioning of the patient and thestatus of disease outside the

skull.
   更困难的问题是，何时将立体定向治疗转向全脑放射治疗。这里没有明确的答案，并且对“临床判断”这个课题非常失败 。在写这个帖子之前ASTRO（美国放射和肿瘤治疗协会）一个摘要的讨论 ，有许多病人目前并没有从立体转到全脑治疗，尽管颅内再三转移。 在抉择全脑放疗与立体定向治疗时被考虑的因素是有多少个脑转移病灶，病人的整体机能和头部以外的病情状况。

   Having been involved in this forum with patients and theirfamilies, I

would add that side effects from whole brain radiationtherapy can be more

disabling than is often reported in the medicalliterature, and so it seems

that we will likely continue to see aclinical practice shift away from this

option as SRS permeates more ofthe local cancer treatment centers.  In my

opinion, WBRT continues tohave a valuable role in cancer treatment, but at

this point, in thesituation of recurrent brain metastases it is probably

best suited forpatients with many (>4) brain mets, and/or limited survival,

though,in the interest of full disclosure, many of my colleagues

woulddisagree.  There is little consensus about “how many brain

metastasesare too many” for SRS in actual clinical practice.
    参与这个患者及家属们的论坛，我想补充一点全脑放疗的副作用往往比医学报告中所述来的更大，所以我们似乎很可能会通过更多的当地癌症治疗中心继续看到临床实践中偏离SRS这一选择。在我看来， WBRT将在癌症治疗中继续扮演一个有价值的角色，但在同一位置重复发生脑转移瘤这一点上，最好应该是超过一定数量的（ 〉4 大于4个）脑转移，否则生存期受限，但是，因为财务事项充分公开的利益问题，我的许多同僚将不会同意。在临床研究上针对SRS“多少个脑转是过多数量”有一致意见。

即：小于4个病灶的复发脑转，倾向于SRS局部立体定位放疗

[ 本帖最后由 呢喃柠檬 于 2008-12-19 00:37 编辑 ]

呢喃柠檬

Whole Brain Radiation Therapy (WBRT) vs. Stereotactic Radiosurgery (SRS):

Round 20 in the War on Brain Mets
全脑放射治疗（ WBRT ）与立体定向放射治疗（SRS） ： 脑转移20回合会战！
October 4, 2008 - 7:52 pm
The end of September found me in Boston at ASTRO, the annual meeting of

radiation oncologists.  MD Anderson Cancer Center presented their study on

whole brain radiation vs. stereotactic radiation for 1-3 brain metastases

as part of the plenary session, and I wanted to review it with you here and

place it into a broader context of the issues and unknowns of how to best

treat people with 1-3 brain mets.
9月底，我在波士顿举行的ASTRO（美国放射和肿瘤治疗协会）放射肿瘤学家年度会议。

作为全体会议的一个议题，马里兰安德森癌症中心（MDA）提出了他们在1-3个脑转移后选

择全脑放疗或立体定向放射的研究，我想与你们在这里回顾一下，并将其放置到更广泛的

范围内得出结论和如何以最佳方式处理与1-3个脑转移的病人。
    The MDA study was designed to enroll 90 patients, but closed after it

enrolled 58 because of safety signals (one arm looking convincingly

superior to the other).  The study took 7 years to enroll.  It was closed

early when there was worse neurocognitive decline (examining learning and

memory at 4 months post treatment using a test to recall a list of 12

words) in patients receiving WBRT+SRS vs. SRS alone.  There was a 49%

decrease in function with WBRT+SRS vs. 23% in SRS alone.  The patients in

the WBRT arm received 30 Gy/12 fractions over 2 weeks, or 2.5 Gy/radiation

treatment.  The in-brain control rate was better in the WBRT arm (no in-

brain disease recurrence at 1 year out from treatment) vs SRS (1/3 of

patients had further tumor in their brain, though over half of patients

never got WBRT within their remaining lives).  Importantly, the overall

survival of patients in the SRS arm was much better, a finding that is

unexpected and unexplainable on the basis of the radiation treatment

received for brain metastases.MDA的研究有计划地招收了90例病人，但最终招收了58

个，因为安全信号（一边看起来令人信服地优于另一种手段） 。研究耗费了7年时间注册

，却因为神经损伤加剧而提前结束（研究学习和记忆在4个月的使用后处理的测试回顾清单

12字） ，患者接受WBRT +SRS与单独的SRS进行比较。WBRT +SRS治疗的有49 ％下降，而

单独的SRS有23 ％下降。接受WBRT的一边在2周内接受30 Gy/12次的治疗，或2.5戈瑞/辐

射治疗。接受WBRT的这一边脑内控制比较好（一年内没有脑内复发），而SRS（1/3的病人

脑内肿瘤进展，但一半以上的病人没有在其剩余的时间内接受WBRT治疗）。重要的是，

SRS这一边的病人整体生存期要好得多，这一发现在脑转后放射治疗的基础上看是意外的而

且令人费解的。

So, the study adds more information to the debate on how to treat patients

in this group.  For a single met, few people would recommend WBRT, and for

4 or more mets, WBRT remains the standard of care.  While this study

appears internally consistent (following good statistical practices), the

difference in survival based on brain radiation suggests some kind of

imbalance of tumor burden between the two arms of the study, which may have

just been a statistical fluke.  What about external validity – ie, do we

believe the results relate to patients overall?  Here several questions

arise.因此，研究小组增加入组条件。对于单发脑转，很少人会建议WBRT ，而4个或更多

的转移，WBRT仍然是标准的护理。虽然这一研究结果在内部得到一致认同而刊登（依据优

良的统计学方法），脑放射提示两种手段间某种肿瘤负担的不平衡，基于此得出两边的生

存期差异可能仅仅是一个统计侥幸。那么外部有效性呢？-即，我们是否相信这个结果能推

及到整体患者？

MDA is a massive cancer center, helping thousands of patients each year.  

For it to take 7 years to enroll a trial of 58 patients is worrisome.   

What that tells me is that there was probably unconscious bias at play in

which patients were offered study treatment, though the study was

randomized, which should have balanced this out. I would like to see what

percentage of patients that were eligible for such a study chose to

participate.  I also cannot explain the worse overall survival with WBRT,

and that again suggests that there may have been an imbalance between the

two arms, in terms of extent of disease.  The presentation did not indicate

anything that was substantially different between the two groups of

patients, but a more detailed look is worthwhile in my opinion.  My

skepticism partially arises because there are other studies – such as a

Japanese study led by Dr. Aoyama ( here ) - that showed the reverse:  

patients with WBRT + SRS lived over twice as long as those with SRS alone

(16.5 vs 7.6 months).MDA是一个庞大的癌症中心，每年给与成千上万的病人帮助。对

于它花费7年时间去做一个58例的试验的结论令人担忧。它告诉我，这里可能存在无意识的

偏见在选择何种患者加入研究治疗，虽然这项研究用随机的方式来平衡这一偏见。我想看

看有多大比例的患者能够获得参与的资格。我也无法解释整体恶化的生存期与WBRT有关

，这再次表明在疾病的广度上这两个手段的研究间存在不平衡。介绍没有充分说明两个小

组间的病人有何不同，在我认为值得去做更详细的探索。我保留部分怀疑，因为恰有另一

研究-如日本由Dr. Aoyama领导的一个研究（在这里） -显示了相反结论：接受WBRT+SRS

的患者和仅接受SRS的差距达到了两倍以上（ 1 6 .5比7 . 6个月）。

The MDA study also did not report on neurocognitive decline following in-

brain recurrence, something that previous studies have noted does occur

(see RTOG study 91-04, abstract here ).  There can be some debate about

whether the way that they measured neurocognitive decline was the best

test, but the difference between the groups is striking, suggesting that it

is a real finding.在MDA的研究也没有报告脑内转移后的神经损伤，这是以前的

研究已经关注到的（见RTOG研究91-04 ，抽象这里 ） 。他们对神经损伤界定的方法是否是最好的，在这里会产生一些争论，但两个小组之间的差异是显着的，表明这是一个真实的调查结果。

Bottom line :  there is mounting evidence that going with SRS alone won’t

harm patients with 1-3 brain metastases, though they do need to be followed

closely and accept that there is about a 1 in 3 chance that they will

require more treatment for brain metastases.  From a toxicity stand point,

as several people on this forum have noted, for some patients there is a

substantial neurologic price to be paid for WBRT and risking that may make

less sense if one can attend regular follow up and accept further treatment

as needed.  SRS is a highly technically complex treatment to deliver, so

the quality of the facility and the number of SRS treatments they deliver

each year is critical (the more the better).
概要：越来越多的证据表明1-3个脑转的病人不会受到单独的SRS治疗的伤害，虽然他们都必须密切注视并且接受有1/3的几率他们将需要再次治疗脑转移瘤。从毒性的立场点，几个人在这个论坛上指出，如果患者愿意参加定期随访并接受进一步必要的治疗，那么对接受WBRT的病人来说，存在神经系统损伤的可能。但如果他们能定期检查并在需要时接受进一步的治疗，这种（神经系统损伤）的可能将被降低。
SRS需要提供高技术含量的治疗，因此，高质量的设备，和病人每年能接受的SRS次数是亟需评定的（越多越好） 。

[ 本帖最后由 呢喃柠檬 于 2008-12-20 14:25 编辑 ]

夜色书香

就是时间有些早了，多谢楼主找出来分享一下。参考的意义还是很明显的。
我差不多2年，只是见过一个脑部全放做了2次的病友，而且效果算是很不错的，生活质量还算可以，获得了延长生命的效果。