Stone Anne, Cooper Jay, Koenig Karen L, Golfinos John G, Oratz Ruth
New York University School of Medicine, New York, New York 10029, USA.
Cancer Invest. 2004;22(4):492-7. doi: 10.1081/cnv-200026387.
A retrospective review of 91 patients with brain metastases from malignant melanoma treated at New York University Medical Center between 1989-1999. Overall survival was the outcome evaluated.
Charts of 91 patients having malignant melanoma with brain metastases were reviewed. Cases were stratified according to therapy: surgical excision, surgical excision plus whole brain radiation therapy, gamma knife stereotactic radiosurgery, gamma knife stereotactic radiosurgery plus whole brain radiation therapy, and whole brain radiation therapy alone. Patients treated with gamma knife stereotactic radiosurgery plus radiation therapy were combined with patients treated with surgical excision plus radiation therapy and compared to those treated with radiation therapy alone. Prognostic characteristics of the two groups were compared and survival curves were generated using the Kaplan-Meier method. The Cox proportional hazards model was used to control for prognostic factors that differed between the groups.
Patients treated with gamma knife stereotactic radiosurgery or surgical excision plus radiation therapy were younger, less likely to present with symptoms, and presented with fewer metastases to the brain than patients treated with radiation therapy alone. A survival benefit of 7.3 months (p = 0.05) was found to be associated with gamma knife radiosurgery or surgical excision plus radiation therapy over radiation therapy alone after controlling for differences in age, number of brain lesions, and presence of symptoms.
This retrospective study of 91 patients treated for melanoma metastases to the brain attempts to examine the effectiveness of different treatments in prolonging survival. Our results suggest that surgical excision or stereotactic radiosurgery with gamma knife in addition to radiation therapy may be more effective than radiation alone at prolonging survival for patients with a limited number of brain lesions.
Survival of patients with melanoma metastases to the brain may be prolonged by treatment with gamma knife stereotactic radiosurgery or surgical excision plus whole brain radiation therapy.
对1989年至1999年间在纽约大学医学中心接受治疗的91例恶性黑色素瘤脑转移患者进行回顾性研究。评估的结果是总生存期。
回顾了91例患有恶性黑色素瘤脑转移患者的病历。病例根据治疗方法进行分层：手术切除、手术切除加全脑放射治疗、伽玛刀立体定向放射外科治疗、伽玛刀立体定向放射外科治疗加全脑放射治疗以及单纯全脑放射治疗。将接受伽玛刀立体定向放射外科治疗加放射治疗的患者与接受手术切除加放射治疗的患者合并，并与单纯接受放射治疗的患者进行比较。比较两组的预后特征，并使用Kaplan-Meier方法生成生存曲线。使用Cox比例风险模型控制两组之间不同的预后因素。
与单纯接受放射治疗的患者相比，接受伽玛刀立体定向放射外科治疗或手术切除加放射治疗的患者更年轻，出现症状的可能性更小，脑转移灶也更少。在控制了年龄差异、脑转移灶数量和症状存在情况后，发现伽玛刀放射外科治疗或手术切除加放射治疗与单纯放射治疗相比，生存期延长了7.3个月（p = 0.05）。
这项对91例黑色素瘤脑转移患者的回顾性研究试图检验不同治疗方法在延长生存期方面的有效性。我们的结果表明，对于脑转移灶数量有限的患者，除放射治疗外，手术切除或伽玛刀立体定向放射外科治疗可能比单纯放射治疗更有效地延长生存期。
伽玛刀立体定向放射外科治疗或手术切除加全脑放射治疗可延长黑色素瘤脑转移患者的生存期。
