PURPOSE Prospective studies have demonstrated increased local control with the addition of a radiosurgery (SRS) boost to whole-brain irradiation (WBRT) in patients with brain metastases. However, the clinical application of SRS boost can be limited by several factors, including tumor size, numbers of lesions, and high cost of care. Here, we investigate the use of WBRT with a simultaneous integrated boost (SIB) to visible lesions in patients with brain metastases. MATERIALS From 2011 to 2016, patients were prospectively enrolled and prescribed a dose of 25 or 37.5 Gray (Gy) WBRT with a SIB dose of 45 or 52.5 Gy to the gross lesions in 10 or 15 fractions, respectively. All plans were optimized for dose coverage of the whole brain and lesions using volumetric arc therapy (VMAT). Comprehensive neurocognitive and quality of life assessments were conducted at baseline and at follow-up. RESULTS Thirteen patients were treated on this protocol. The 1-year local control rates were 92% at the patient level, and 98.6% at the lesion level. The overall 1-year intracranial control was 46%. Patients had no significant declines in Mini-Mental State Examination (MMSE), Hopkins Verbal Learning Test-Revised (HVLT-R), and Medical Outcomes Study (MOS) Cognitive Functional status scores pre- and post-treatment. CONCLUSION WBRT with SIB to gross lesions using VMAT planning appears to be safe and effective in the treatment of brain metastases without significant cognitive decline. This treatment strategy should be considered in those patients with a high number of metastases or ones not amenable for radiosurgery. CLINICAL TRIAL REGISTRATION CODE NCT01218542.

中文翻译：

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全脑放射治疗同时进行场内增强（SIB）治疗脑转移的结果。

目的前瞻性研究表明，对于脑转移患者，增加放射外科手术（SRS）以增强全脑照射（WBRT）可以增强局部控制。但是，SRS加强免疫疗法的临床应用可能受到几个因素的限制，包括肿瘤大小，病变数量和高昂的治疗费用。在这里，我们调查了WBRT与同时整合增强（SIB）对脑转移患者可见病变的使用。材料从2011年至2016年，对患者进行前瞻性研究，并分别以25或37.5 Gy WBRT和45或52.5 Gy的SIB剂量开具10或15分数的总病变。使用容积弧光疗法（VMAT）对所有计划进行了优化，以覆盖整个大脑和病变的剂量。在基线和随访时进行了全面的神经认知和生活质量评估。结果按照该方案治疗了13名患者。患者一级的一年局部控制率为92％，病变一级为98.6％。总体1年颅内控制为46％。在治疗前后，患者的迷你精神状态检查（MMSE），霍普金斯言语学习测试修订（HVLT-R）和医学成果研究（MOS）认知功能状态评分均无明显下降。结论采用VMAT计划将WBRT与SIB结合用于严重病变似乎在治疗脑转移瘤方面是安全有效的，而不会出现明显的认知下降。对于那些有大量转移或不适合放射外科手术的患者，应考虑这种治疗策略。