Davey P, Schwartz M L, Scora D, Gardner S, O'Brien P F
Division of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada.
Br J Neurosurg. 2007 Oct;21(5):491-5. doi: 10.1080/02688690701534722.
Radiosurgery is conventionally prescribed for brain metastases with a single dose of radiation. Fractionation has been advocated to improve tumour control. A multivariate analysis of prognostic factors including fractionation has been performed in two consecutive prospective radiosurgery protocols with and without fractionation in order to identify an association, if any, between fractionation and survival. A surgically applied stereotactic head frame was used. Radiosurgery planning was based on a contrast-enhanced CT. Sixty-nine patients underwent the two-fraction regimen and 35 patients had a single treatment. Multivariate analysis showed that the presence of extracranial malignancy, performance status, multiple brain metastases, patient gender and the time from the initial treatment to radiosurgery were independent determinants for survival. Fractionation was also an independent determinant with two-fraction patients surviving a median of 30 weeks versus single fraction patients who survived a median of 16 weeks. Fractionated radiosurgery was associated with improved survival and deserves further investigation.
传统上，放射外科手术是对脑转移瘤采用单次放射剂量。分次放疗已被提倡用于改善肿瘤控制。在两个连续的前瞻性放射外科手术方案中，对包括分次放疗在内的预后因素进行了多变量分析，这两个方案分别采用了分次放疗和未采用分次放疗，以便确定分次放疗与生存之间是否存在关联（若有的话）。使用了手术应用的立体定向头架。放射外科手术规划基于增强CT。69例患者接受了两次分割方案，35例患者接受了单次治疗。多变量分析表明，颅外恶性肿瘤的存在、体能状态、多发脑转移、患者性别以及从初始治疗到放射外科手术的时间是生存的独立决定因素。分次放疗也是一个独立决定因素，接受两次分割的患者中位生存期为30周，而接受单次分割的患者中位生存期为16周。分次放射外科手术与生存率提高相关，值得进一步研究。
