Petrovich Zbigniew, Yu Cheng, Giannotta Steven L, O'Day Steven, Apuzzo Michael L J
The Departments of Radiation Oncology and Neurological Surgery, University of Southern California School of Medicine, Los Angeles, USA.
J Neurosurg. 2002 Dec;97(5 Suppl):499-506. doi: 10.3171/jns.2002.97.supplement.
Gamma knife radiosurgery (GKS) has become a well-established treatment modality in the management of selected patients with brain metastasis. The authors review the management patients with these tumors treated at a single center.
Between 1994 and 2002, 458 consecutive patients with metastatic brain disease underwent GKS. There were 1305 lesions treated in 680 separate sessions. The histological diagnosis was melanoma in 231 (50%), lung cancer in 94 (20.5%), breast cancer in 38 (8.3%), renal cell carcinoma (RCC) in 29 (6.3%), colon carcinoma in 13 (2.8%), unknown primary site in 14 (3.1%), and other in 39 patients (8.5%). The median tumor volume was 0.9 cm3 and the median volume treated was 2.3 cm3. The median radiation dose was 18 Gy prescribed to a median isodose of 60%; the median dose was 20 Gy in melanoma, sarcoma, and RCC. Whole-brain radiotherapy (WBRT) either prior to or following GKS was performed in 114 patients (25%). Follow up ranged from 3 to 84 months with a median of 9 months. The median survival for all patients was 9 months and depended on tumor histology. Survival ranged from 6 months for patients with colon carcinoma, unknown primary tumors, and other tumors to 17 months for those with breast cancer. Median survival in patients with melanoma was 8 months. In multivariate analysis Karnofsky Performance Scale score (< 70 vs > 70), status of systemic disease (yes vs no), histological diagnosis, and total intracranial tumor volume were the only significant factors influencing survival. The number of brain metastases (one-five), WBRT (yes vs no), and age were not significant. Pattern of failure was different in patients with melanoma compared with those with other diagnoses. Cause of death in patients with melanoma was in 50% of the cases due to systemic disease and in 42% due to central nervous system causes, whereas it was 70% for the former and 23% for the latter in patients with other diagnoses. The treatment was well tolerated with significant late toxicity requiring craniotomy for removal of a necrotic focus in only 20 patients (4.7%).
Gamma knife radiosurgery provided an excellent palliation with low incidence of toxicity. A Phase III prospective randomized trial is required to define the role of WBRT in combination with GKS.
伽玛刀放射外科治疗（GKS）已成为治疗特定脑转移瘤患者的一种成熟治疗方式。作者回顾了在单一中心接受治疗的这些肿瘤患者的治疗情况。
1994年至2002年间，458例连续性脑转移瘤患者接受了GKS治疗。共进行了680次单独治疗，治疗了1305个病灶。组织学诊断为黑色素瘤231例（50%），肺癌94例（20.5%），乳腺癌38例（8.3%），肾细胞癌（RCC）29例（6.3%），结肠癌13例（2.8%），原发部位不明14例（3.1%），其他39例（8.5%）。肿瘤中位体积为0.9 cm³，中位治疗体积为2.3 cm³。中位放射剂量为18 Gy，处方中位等剂量线为60%；黑色素瘤、肉瘤和RCC的中位剂量为20 Gy。114例患者（25%）在GKS之前或之后接受了全脑放疗（WBRT）。随访时间为3至84个月，中位时间为9个月。所有患者的中位生存期为9个月，且取决于肿瘤组织学类型。结肠癌、原发肿瘤不明和其他肿瘤患者的生存期为6个月，乳腺癌患者为17个月。黑色素瘤患者的中位生存期为8个月。多因素分析显示，卡氏功能状态评分（<70分与>70分）、全身疾病状态（有与无）、组织学诊断和颅内肿瘤总体积是影响生存期的唯一显著因素。脑转移瘤数量（1至5个）、WBRT（有与无）和年龄无显著影响。黑色素瘤患者与其他诊断患者的失败模式不同。黑色素瘤患者的死亡原因在50%的病例中是由于全身疾病，42%是由于中枢神经系统原因，而其他诊断患者中前者为70%，后者为23%。该治疗耐受性良好，仅20例患者（4.7%）出现严重晚期毒性，需要开颅切除坏死灶。
伽玛刀放射外科治疗提供了良好的姑息治疗效果，毒性发生率低。需要进行一项III期前瞻性随机试验来确定WBRT与GKS联合应用的作用。
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