Simonová G, Liscák R, Novotný J, Novotný J
Stereotactic and Radiation Neurosurgery Department, Hospital Na Homolce, Roentgenova 2, 151 19 5, Prague, Czech Republic.
Radiother Oncol. 2000 Nov;57(2):207-13. doi: 10.1016/s0167-8140(00)00267-x.
To analyze treatment results, complications, prognostic factors and their statistical significance in surviving patients treated with the Leksell gamma knife (LGK) for solitary brain metastases.
Between 1992-1998, 237 patients were treated with solitary brain metastasis (SBM). The histological subtypes were as follows: 101 patients (42.6%) non small-cell lung cancer, 42 (17.7%) renal cell carcinoma, 36 (15.2%) breast carcinoma, 30 (12.7%) colorectal carcinomas and 28 (11.8%) melanoma.
A complete or partial regression was observed in 193 (81.4%) patients, cessation of growth activity in 32 (13.5%) and local progression in 12 (5.1%). Local recurrence was observed in nine (4.7%) of 193 patients with complete or partial regression. Acute toxicity appeared in 24 (10%) patients (score 3.4), late complications (score 3.4) were observed in 13 patients (5.5%). Out of 237 patients, 182 patients died with a median survival of 6 months and 55 patients are still alive with a median survival 12 months and with a minimal follow up period of 10 months. The significant prognostic factors for longer survival in these series of patients were: Karnofsky performance status (70% or more), the extent of extra-cerebral disease (no extra-cerebral disease), pretreatment neurological symptoms neurological functional class (NFC 1), histology (renal cell and breast carcinomas) and the dose to the planning target volume (20 Gy and higher).
Radiosurgery provides an effective local control for 90% of treated patients with low morbidity. Several significant prognostic factors were detected for patients' survival. These factors can help to predict better patients' survival after the LGK treatment.
分析使用Leksell伽玛刀（LGK）治疗孤立性脑转移瘤的存活患者的治疗效果、并发症、预后因素及其统计学意义。
1992年至1998年间，237例患者接受了孤立性脑转移瘤（SBM）的治疗。组织学亚型如下：101例（42.6%）非小细胞肺癌，42例（17.7%）肾细胞癌，36例（15.2%）乳腺癌，30例（12.7%）结直肠癌，28例（11.8%）黑色素瘤。
193例（81.4%）患者出现完全或部分缓解，32例（13.5%）生长活动停止，12例（5.1%）局部进展。193例完全或部分缓解的患者中有9例（4.7%）出现局部复发。24例（10%）患者出现急性毒性反应（评分3.4），13例（5.5%）患者出现晚期并发症（评分3.4）。237例患者中，182例死亡，中位生存期为6个月，55例仍存活，中位生存期为12个月，最短随访期为10个月。在这一系列患者中，生存期较长的显著预后因素为：卡诺夫斯基功能状态（70%或更高）、脑外疾病范围（无脑外疾病）、治疗前神经症状、神经功能分级（NFC 1）、组织学类型（肾细胞癌和乳腺癌）以及计划靶体积的剂量（20 Gy及更高）。
放射外科手术为90%的接受治疗患者提供了有效的局部控制，且发病率较低。检测到了几个影响患者生存的显著预后因素。这些因素有助于预测LGK治疗后患者的更好生存情况。
