Kondziolka Douglas, Martin Juan J, Flickinger John C, Friedland David M, Brufsky Adam M, Baar Joseph, Agarwala Sanjiv, Kirkwood John M, Lunsford L Dade
Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, PA 15213, USA.
Cancer. 2005 Dec 15;104(12):2784-91. doi: 10.1002/cncr.21545.
Stereotactic radiosurgery, with or without whole-brain radiation therapy, has become a valued management choice for patients with brain metastases, although their median survival remains limited. In patients who receive successful extracranial cancer care, patients who have controlled intracranial disease are living longer. The authors evaluated all brain metastasis in patients who lived for > or = 4 years after radiosurgery to determine clinical and treatment patterns potentially responsible for their outcome.
Six hundred seventy-seven patients with brain metastases underwent 781 radiosurgery procedures between 1988 and 2000. Data from the entire series were reviewed; and, if patients had > or = 4 years of survival, then they were evaluated for information on brain and extracranial treatment, symptoms, imaging responses, need for further care, and management morbidity. These long-term survivors were compared with a cohort who lived for < 3 months after radiosurgery (n = 100 patients).
Forty-four patients (6.5%) survived for > 4 years after radiosurgery (mean, 69 mos with 16 patients still alive). The mean age at radiosurgery was 53 years (maximum age, 72 yrs), and the median Karnofsky performance score (KPS) was 90. The lung (n = 15 patients), breast (n = 9 patients), kidney (n = 7 patients), and skin (melanoma; n = 6 patients) were the most frequent primary sites. Two or more organ sites outside the brain were involved in 18 patients (41%), the primary tumor plus lymph nodes were involved in 10 patients (23%), only the primary tumor was involved in 9 patients (20%), and only brain disease was involved in 7 patients (16%), indicating that extended survival was possible even in patients with multiorgan disease. Serial imaging of 133 tumors showed that 99 tumors were smaller (74%), 22 tumors were unchanged (17%), and 12 tumors were larger (9%). Four patients had a permanent neurologic deficit after brain tumor management, and six patients underwent a resection after radiosurgery. Compared with the patients who had limited survival (< 3 mos), long-term survivors had a higher initial KPS (P = 0.01), fewer brain metastases (P = 0.04), and less extracranial disease (P < 0.00005).
Although the expected survival of patients with brain metastases may be limited, selected patients with effective intracranial and extracranial care for malignant disease can have prolonged, good-quality survival. The extent of extracranial disease at the time of radiosurgery was predictive of outcome, but this does not necessarily mean that patients cannot live for years if treatment is effective.
立体定向放射外科手术，无论是否联合全脑放射治疗，已成为脑转移瘤患者一种重要的治疗选择，尽管其生存中位数仍然有限。在接受成功的颅外癌症治疗的患者中，颅内疾病得到控制的患者生存期更长。作者评估了立体定向放射外科手术后存活≥4年的患者的所有脑转移情况，以确定可能对其预后产生影响的临床和治疗模式。
1988年至2000年间，677例脑转移瘤患者接受了781次立体定向放射外科手术。回顾了整个系列的数据；如果患者存活≥4年，则评估其脑和颅外治疗、症状、影像学反应、进一步治疗需求及治疗相关并发症等信息。将这些长期存活者与一组立体定向放射外科手术后存活<3个月的患者（n = 100例）进行比较。
44例患者（6.5%）在立体定向放射外科手术后存活>4年（平均69个月，16例患者仍存活）。立体定向放射外科手术时的平均年龄为53岁（最大年龄72岁），卡氏功能状态评分（KPS）中位数为90。最常见的原发部位是肺（n = 15例患者）、乳腺（n = 9例患者）、肾（n = 7例患者）和皮肤（黑色素瘤；n = 6例患者）。18例患者（41%）脑外有两个或更多器官部位受累，10例患者（23%）原发肿瘤加淋巴结受累，9例患者（20%）仅原发肿瘤受累，7例患者（16%）仅脑部疾病受累，这表明即使是多器官疾病患者也可能延长生存期。对133个肿瘤的系列影像学检查显示，99个肿瘤缩小（74%），22个肿瘤大小不变（17%），12个肿瘤增大（9%）。4例患者在脑肿瘤治疗后出现永久性神经功能缺损，6例患者在立体定向放射外科手术后接受了切除术。与生存期有限（<3个月）的患者相比，长期存活者初始KPS更高（P = 0.01），脑转移瘤更少（P = 0.04），颅外疾病更少（P < 0.00005）。
尽管脑转移瘤患者的预期生存期可能有限，但对恶性疾病进行有效的颅内和颅外治疗的特定患者可以获得延长的、高质量的生存期。立体定向放射外科手术时颅外疾病的范围可预测预后，但这并不一定意味着如果治疗有效患者不能存活数年。
