Amendola B E, Wolf A L, Coy S R, Amendola M, Bloch L
Miami Neuroscience Center Coral Gables, Florida, USA.
Cancer J. 2000 Mar-Apr;6(2):88-92.
The purpose of the study was to evaluate the results of gamma knife radiosurgery for treatment of brain metastases from carcinoma of the breast.
From December 1993 to July 1998, 68 women with breast carcinoma metastatic to the brain were treated with gamma knife radiosurgery at Miami Neuroscience Center in Coral Gables, Florida. The ages ranged from 25 to 80 years, with a median age of 52 years. Thirty-eight patients had previously received conventional modalities of treatment for brain metastases including whole-brain irradiation. A total of 110 treatments were given to the 68 women to an average of eight tumor sites per patient. Minimum doses ranged from 6 to 25 Gy to the 35% to 85% isodose line, with 95% of the prescribed minimum doses ranging from 15 to 24 Gy. Patients were treated for one to three lesions (n = 26), four to seven lesions (n = 18), and eight or more lesions (n = 24).
The median overall actuarial survival for the entire group was 7.8 months. The actuarial survival was 32% at 1 year. The median follow-up was 7.8 months. Overall local control by lesion was 94% (485/518 lesions), and average tumor volume was 3.3 cm3. Twenty-seven (40%) of 68 eligible patients survived 1 year, nine (13%) survived 2 years, and two (3%) survived more than 3 years. Fifty-one of 56 documented deaths (91%) were unrelated to brain metastases. In a subgroup of 15 patients with single brain metastases, the average tumor volume was 16.6 cm3, and local control was 73% (11/15 lesions). The 15 patients who died had a median survival of 7.7 months (range, 3 to 45.7 months).
Gamma knife radiosurgical treatment of patients with brain metastases from carcinoma of the breast has shifted the question of survival to that of systemic control. There was no radiation-induced dementia, and a remarkably low incidence of local failure was seen. Survival has been found to be independent of the number of lesions treated.
本研究旨在评估伽玛刀放射外科治疗乳腺癌脑转移瘤的效果。
1993年12月至1998年7月，68例乳腺癌脑转移女性患者在佛罗里达州科勒尔盖布尔斯的迈阿密神经科学中心接受了伽玛刀放射外科治疗。年龄范围为25至80岁，中位年龄为52岁。38例患者先前已接受包括全脑照射在内的脑转移瘤传统治疗方式。68例女性患者共接受了110次治疗，平均每位患者有8个肿瘤部位。最小剂量在6至25 Gy之间，照射至35%至85%等剂量线，规定最小剂量的95%在15至24 Gy之间。患者治疗1至3个病灶（n = 26）、4至7个病灶（n = 18）以及8个或更多病灶（n = 24）。
整个组的中位总精算生存率为7.8个月。1年时的精算生存率为32%。中位随访时间为7.8个月。按病灶计算的总体局部控制率为94%（485/518个病灶），平均肿瘤体积为3.3 cm³。68例符合条件的患者中，27例（40%）存活1年，9例（13%）存活2年，2例（3%）存活超过3年。56例已记录死亡病例中有51例（91%）与脑转移无关。在15例单发脑转移瘤患者亚组中，平均肿瘤体积为16.6 cm³，局部控制率为73%（11/15个病灶）。死亡的15例患者中位生存期为7.7个月（范围为3至45.7个月）。
伽玛刀放射外科治疗乳腺癌脑转移瘤患者已将生存问题转移至全身控制问题。未出现放射性痴呆，且局部失败发生率极低。已发现生存与治疗的病灶数量无关。
