Koc Mehmet, McGregor John, Grecula John, Bauer Constance J, Gupta Nilendu, Gahbauer Reinhard A
Division of Radiation Oncology, Arthur G. James Cancer Hospital and Research Institute, The Ohio State University, Columbus, OH, USA.
J Neurooncol. 2005 Feb;71(3):307-13. doi: 10.1007/s11060-004-2027-1.
Objective of this study was to evaluate retrospectively the effectiveness of Gamma Knife radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to survival. Twenty-six patients with intracranial metastases (72 lesions) from melanoma underwent Gamma Knife radiosurgery. In 14 patients (54%) whole-brain radiotherapy (WBRT) was performed as part of the initial treatment, and in 12 patients (38%) immunotherapy and/or chemotherapy was given after Gamma Knife radiosurgery. The median tumor volume for Gamma Knife radiosurgery treated lesions was 1.72 cm3. The median prescribed radiation dose was 18 Gy (range 8-22 Gy) typically prescribed to the isodose at the tumor margin. Univariate and multivariate analyses were used to determine significant prognostic factors affecting survival. Overall median survival was 6 months after Gamma Knife radiosurgery, and 1-year survival was 25%. The median survival from the onset of brain metastases was 9 months and from the original diagnosis of melanoma was 50 months (range 4-160 months). There were no major acute or late GKS complications. In univariate testing, the Karnofsky score equal to or higher than 90% (P < 0.01, log-rank test), supratentorial localization (P < 0.001, log-rank test), intracranial tumor volume less than 1 cm3 (P < 0.02, log-rank test), and absence of neurological signs or symptoms before Gamma Knife radiosurgery (P < 0.003, log-rank test) were significant favorable factors for survival. In multivariate regression analyses, the most important predictors associated with increased survival were a KPS > or = 90 (P < 0.023), female sex (P < 0.004), supratentorial localization (P < 0.01), and absence of neurological symptoms (P < 0.008). Radiosurgery is a noninvasive, safe, and effective treatment option for patients with single or multiple intracranial metastases from melanoma. Female sex, Karnofsky score > or = 90, supratentorial localization and lack of symptoms before the Gamma Knife radiosurgery were good independent predictors of survival.
本研究的目的是回顾性评估伽玛刀放射外科治疗颅内转移性黑色素瘤的有效性，并确定与生存相关的预后因素。26例黑色素瘤颅内转移患者（72个病灶）接受了伽玛刀放射外科治疗。14例患者（54%）在初始治疗中接受了全脑放疗（WBRT），12例患者（38%）在伽玛刀放射外科治疗后接受了免疫治疗和/或化疗。伽玛刀放射外科治疗病灶的中位肿瘤体积为1.72 cm³。中位处方放射剂量为18 Gy（范围8 - 22 Gy），通常针对肿瘤边缘的等剂量线进行处方。采用单因素和多因素分析来确定影响生存的显著预后因素。伽玛刀放射外科治疗后总体中位生存期为6个月，1年生存率为25%。脑转移开始后的中位生存期为9个月，黑色素瘤原诊断后的中位生存期为50个月（范围4 - 160个月）。没有重大的急性或晚期伽玛刀并发症。在单因素测试中，卡诺夫斯基评分等于或高于90%（P < 0.01，对数秩检验）、幕上定位（P < 0.001，对数秩检验）、颅内肿瘤体积小于1 cm³（P < 0.02，对数秩检验）以及伽玛刀放射外科治疗前无神经体征或症状（P < 0.003，对数秩检验）是生存的显著有利因素。在多因素回归分析中，与生存增加相关的最重要预测因素是KPS≥90（P < 0.023）、女性（P < 0.004）、幕上定位（P < 0.01）以及无神经症状（P < 0.008）。放射外科是黑色素瘤单发或多发颅内转移患者的一种无创、安全且有效的治疗选择。女性、卡诺夫斯基评分≥90、幕上定位以及伽玛刀放射外科治疗前无症状是生存的良好独立预测因素。
