Gaudy-Marqueste Caroline, Regis Jean-Marie, Muracciole Xavier, Laurans Renaud, Richard Marie-Aleth, Bonerandi Jean-Jacques, Grob Jean-Jacques
Dermatology Department, Hôpital Sainte Marguerite, Marseille, France.
Int J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):809-16. doi: 10.1016/j.ijrobp.2006.01.024. Epub 2006 May 6.
To assess retrospectively a strategy that uses Gamma-Knife radiosurgery (GKR) in the management of patients with brain metastases (BMs) of malignant melanoma (MM).
GKR without whole-brain radiotherapy (WBRT) was performed for patients with Karnofsky Performance Status (KPS) of 60 or above who harbored 1 to 4 BMs of 30 mm or less and was repeated as often as needed. Survival was assessed in the whole population, whereas local-control rates were assessed for patients with follow-up longer than 3 months.
A total of 221 BMs were treated in 106 patients; 61.3% had a single BM. Median survival from the time of GKR was 5.09 months. Control rate of treated BMs was 83.7%, with 14% of complete response (14 BMs), 42% of partial response (41 BMs), and 43% of stabilization (43 BMs). In multivariate analysis, survival prognosis factors retained were KPS greater than 80, cortical or subcortical location, and Score Index for Radiosurgery (SIR) greater than 6. On the basis of KPS, BM location, and age, a score called MM-GKR, predictive of survival in our population, was defined.
Gamma-Knife radiosurgery provides a surgery-like ability to obtain control of a solitary BM and could be consider as an alternative treatment to the combination of GKR+WBRT as a palliative strategy. MM-GKR classification is more adapted to MM patients than are SIR, RPA and Brain Score for Brain Metastasis.
回顾性评估一种使用伽玛刀放射外科治疗（GKR）来管理恶性黑色素瘤（MM）脑转移瘤（BM）患者的策略。
对卡氏功能状态（KPS）为60或以上、有1至4个直径30毫米或更小的脑转移瘤的患者进行不联合全脑放疗（WBRT）的GKR治疗，并根据需要重复进行。对全体患者评估生存率，而对随访时间超过3个月的患者评估局部控制率。
106例患者共治疗221个脑转移瘤；61.3%有单个脑转移瘤。从进行GKR时起的中位生存期为5.09个月。治疗的脑转移瘤的控制率为83.7%，其中完全缓解率为14%（14个脑转移瘤），部分缓解率为42%（41个脑转移瘤），病情稳定率为43%（43个脑转移瘤）。多因素分析中，保留的生存预后因素为KPS大于80、皮质或皮质下位置以及放射外科评分指数（SIR）大于6。基于KPS、脑转移瘤位置和年龄，定义了一个名为MM-GKR的评分，可预测我们研究人群的生存率。
伽玛刀放射外科提供了类似手术的能力来控制孤立性脑转移瘤，可被视为作为姑息治疗策略的GKR+WBRT联合治疗的替代方案。MM-GKR分类比SIR、RPA和脑转移瘤脑评分更适合MM患者。
