Hoffman R, Sneed P K, McDermott M W, Chang S, Lamborn K R, Park E, Wara W M, Larson D A
Department of Radiation Oncology, University of California, San Francisco 94143-0226, USA.
Cancer J. 2001 Mar-Apr;7(2):121-31.
Brain metastases are a common problem in patients with lung cancer. This retrospective review was performed to describe the efficacy and toxicity of stereotactic radiosurgery for brain metastases from lung carcinoma and to evaluate prognostic factors for survival.
A retrospective review was performed of 113 patients with the diagnosis of lung carcinoma who underwent radiosurgery with or without whole-brain radiotherapy for management of newly diagnosed or recurrent, single, or multiple brain metastases from 1991 through 1998 at the University of California, San Francisco. Freedom from progression and survival were measured from the date of radiosurgery and estimated using the Kaplan-Meier method. Prognostic factors were evaluated with the log-rank test and Cox proportional hazards models.
The median patient age at the time of radiosurgery was 59 years (range, 37-82 years), and the median Karnofsky performance score was 90 (range, 50-100). The median survival time from radiosurgery was 12.0 months overall, 13.9 months for 41 patients treated with radiosurgery alone initially, 14.5 months for 19 patients treated with radiosurgery and whole-brain radiotherapy initially, and 10.0 months for 53 patients with recurrent brain metastases. Among newly diagnosed patients, multivariate analysis showed that improved survival was associated with absence of extracranial metastases and fewer brain metastases. Among patients with recurrent brain metastases, improved survival was associated with higher Karnofsky performance score, control of the primary tumor, and fewer metastases. Measured by lesion, 1-year local freedom from progression probabilities were 81% for radiosurgery alone, 86% for radiosurgery and whole-brain radiotherapy, and 65% for radiosurgery performed after recurrence. In patients with newly diagnosed brain metastases, there was a significantly greater risk of developing subsequent brain metastases and of worse overall brain freedom from progression after radiosurgery alone versus radiosurgery and whole-brain radiotherapy. One-year brain freedom from progression probabilities were 13% without salvage therapy and 62% with salvage therapy in the 41 patients treated initially with radiosurgery alone, versus 67% without salvage therapy and 89% with salvage therapy in the 19 patients treated initially with radiosurgery plus whole-brain radiotherapy.
Radiosurgery is an effective therapy for selected patients with newly diagnosed or recurrent brain metastases from lung carcinoma. Initial whole-brain radiotherapy with radiosurgery appears to improve brain control but not survival. Prospective, randomized trials are needed to further investigate the role of radiosurgery with and without whole-brain radiotherapy for brain metastases.
脑转移是肺癌患者常见的问题。本回顾性研究旨在描述立体定向放射外科治疗肺癌脑转移的疗效和毒性，并评估生存的预后因素。
对1991年至1998年在加利福尼亚大学旧金山分校接受放射外科治疗（无论是否联合全脑放疗）以处理新诊断或复发的单发或多发脑转移的113例肺癌患者进行回顾性研究。从放射外科治疗之日起测量无进展生存期和总生存期，并采用Kaplan-Meier法进行估计。用对数秩检验和Cox比例风险模型评估预后因素。
放射外科治疗时患者的中位年龄为59岁（范围37 - 82岁），中位卡诺夫斯基体能状态评分90分（范围50 - 100分）。放射外科治疗后的总中位生存期为12.0个月，41例初始仅接受放射外科治疗的患者为13.9个月, 19例初始接受放射外科治疗联合全脑放疗的患者为14.5个月，53例复发性脑转移患者为10.0个月。在新诊断的患者中，多因素分析显示生存期改善与无颅外转移及较少的脑转移有关。在复发性脑转移患者中，生存期改善与较高的卡诺夫斯基体能状态评分、原发肿瘤得到控制及较少的转移灶有关。按病灶测量，单纯放射外科治疗1年局部无进展概率为81%，放射外科治疗联合全脑放疗为86%，复发后进行放射外科治疗为65%。在新诊断脑转移的患者中，与放射外科治疗联合全脑放疗相比，单纯放射外科治疗后发生后续脑转移的风险显著更高，且总体脑无进展情况更差。在41例初始仅接受放射外科治疗的患者中，无挽救治疗时1年脑无进展概率为13%，有挽救治疗时为62%；而在19例初始接受放射外科治疗加全脑放疗的患者中，无挽救治疗时为67%，有挽救治疗时为89%。
放射外科是治疗特定的新诊断或复发性肺癌脑转移患者的有效方法。放射外科联合初始全脑放疗似乎可改善脑转移控制情况，但不能提高生存率。需要进行前瞻性随机试验以进一步研究放射外科联合或不联合全脑放疗在脑转移治疗中的作用。
