Bhatnagar Ajay K, Flickinger John C, Kondziolka Douglas, Lunsford L Dade
Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):898-903. doi: 10.1016/j.ijrobp.2005.08.035. Epub 2005 Dec 9.
To evaluate the outcomes after a single stereotactic radiosurgery procedure for the care of patients with 4 or more intracranial metastases.
Two hundred five patients with primary malignancies, including non-small-cell lung carcinoma (42%), breast carcinoma (23%), melanoma (17%), renal cell carcinoma (6%), colon cancer (3%), and others (10%) underwent gamma knife radiosurgery for 4 or more intracranial metastases at one time. The median number of brain metastases was 5 (range, 4-18) with a median total treatment volume of 6.8 cc (range, 0.6-51.0 cc). Radiosurgery was used as sole management (17% of patients), or in combination with whole brain radiotherapy (46%) or after failure of whole brain radiotherapy (38%). The median marginal radiosurgery dose was 16 Gy (range, 12-20 Gy). The mean follow-up was 8 months.
The median overall survival after radiosurgery for all patients was 8 months. The 1-year local control rate was 71%, and the median time to progressive/new brain metastases was 9 months. Using the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) classification system, the median overall survivals for RPA classes I, II, and III were 18, 9, and 3 months, respectively (p < 0.00001). Multivariate analysis revealed total treatment volume, age, RPA classification, and marginal dose as significant prognostic factors. The number of metastases was not statistically significant (p = 0.333).
Radiosurgery seems to provide survival benefit for patients with 4 or more intracranial metastases. Because total treatment volume was the most significant predictor of survival, the total volume of brain metastases, rather than the number of metastases, should be considered in identifying appropriate radiosurgery candidates.
评估单次立体定向放射外科手术治疗4个或更多颅内转移瘤患者的疗效。
205例原发性恶性肿瘤患者，包括非小细胞肺癌（42%）、乳腺癌（23%）、黑色素瘤（17%）、肾细胞癌（6%）、结肠癌（3%）和其他（10%），一次性接受伽玛刀放射外科手术治疗4个或更多颅内转移瘤。脑转移瘤的中位数为5个（范围4 - 18个），总治疗体积中位数为6.8立方厘米（范围0.6 - 51.0立方厘米）。放射外科手术作为唯一治疗手段（17%的患者），或与全脑放疗联合使用（46%），或在全脑放疗失败后使用（38%）。放射外科手术的边缘剂量中位数为16 Gy（范围12 - 20 Gy）。平均随访时间为8个月。
所有患者放射外科手术后的总生存期中位数为8个月。1年局部控制率为71%，进展/新发脑转移瘤的中位时间为9个月。使用放射治疗肿瘤学组递归分区分析（RPA）分类系统，RPA I、II和III类的总生存期中位数分别为18、9和3个月（p < 0.00001）。多因素分析显示总治疗体积、年龄、RPA分类和边缘剂量是显著的预后因素。转移瘤数量无统计学意义（p = 0.333）。
放射外科手术似乎能为4个或更多颅内转移瘤患者带来生存益处。由于总治疗体积是生存的最显著预测因素，在确定合适的放射外科手术候选患者时，应考虑脑转移瘤的总体积，而非转移瘤的数量。
