Boyd T S, Mehta M P
Department of Human Oncology, University of Wisconsin Medical School, Madison, USA.
Oncology (Williston Park). 1999 Oct;13(10):1397-409; discussion, 1409-10, 1413.
Worldwide, approximately 100,000 patients have undergone stereotactic radiosurgery for a variety of intracranial lesions, of which brain metastases represent the most common treatment indication. This article summarizes the major issues surrounding the management of brain metastases, and also analyzes 21 independent reports of Gamma Knife- or linear accelerator-based radiosurgery, representing over 1,700 patients and more than 2,700 lesions. Variable reporting in the studies precludes a definitive, rigorous analysis, but the composite data reveal an average local control rate of 83% and median survival of 9.6 months, both of which are comparable to results in recent surgical reports. The most important prognostic factors for survival appear to be fewer than three lesions, controlled extracranial disease, and Karnofsky performance score (KPS). The exact impact of dose has not been clarified, but a dose-response relationship, especially for > or = 18 Gy, is emerging. The role of whole-brain radiotherapy remains unresolved. It may enhance local control but does not convincingly improve survival and, in some series, is associated with an increased risk of late complications. Chronic steroid dependence and increased intracranial edema do not appear to be common problems. This is an opportune time for the completion of ongoing randomized trials to validate these observations.
在全球范围内，约有10万名患者因各种颅内病变接受了立体定向放射外科治疗，其中脑转移瘤是最常见的治疗适应症。本文总结了脑转移瘤治疗中的主要问题，并分析了21篇基于伽玛刀或直线加速器的放射外科独立报告，这些报告涵盖了1700多名患者和2700多个病灶。研究报告的差异使得无法进行明确、严谨的分析，但综合数据显示局部控制率平均为83%，中位生存期为9.6个月，这两者均与近期手术报告的结果相当。生存的最重要预后因素似乎是病灶少于三个、颅外疾病得到控制以及卡诺夫斯基表现评分（KPS）。剂量的确切影响尚未明确，但剂量反应关系正在显现，尤其是对于≥18 Gy的剂量。全脑放疗的作用仍未解决。它可能会提高局部控制率，但并未令人信服地改善生存率，并且在一些系列研究中，与晚期并发症风险增加有关。慢性类固醇依赖和颅内水肿增加似乎并非常见问题。现在是完成正在进行的随机试验以验证这些观察结果的适当时机。
