Mathieu David, Kondziolka Douglas, Flickinger John C, Fortin David, Kenny Brendan, Michaud Karine, Mongia Sanjay, Niranjan Ajay, Lunsford L Dade
Division of Neurosurgery/Neuro-oncology, Centre Hospitalier University of Sherbrooke, Sherbrooke, Canada.
Neurosurgery. 2008 Apr;62(4):817-23; discussion 823-4. doi: 10.1227/01.neu.0000316899.55501.8b.
Adjuvant irradiation after resection of brain metastases reduces the risk of local recurrence. Whole-brain radiation therapy can be associated with significant neurotoxicity in long-term survivors of brain metastases. This retrospective study evaluates the role of tumor bed stereotactic radiosurgery as an alternative method of irradiation after initial resection of brain metastases to prevent local recurrence.
Forty patients underwent tumor bed radiosurgery after resection of brain metastases at two separate academic medical centers. The median age was 59.5 years. Twenty patients (67.5%) had single metastases. Resection was complete in 80% and partial in 20% of the patients. At the time of radiosurgery, systemic disease was active in 57.5%, inactive in 32.5%, and in remission in 10% of the patients. The median Karnofsky Performance Scale score was 80% (range, 60-100%). Radiosurgery was performed a median of 4 weeks after tumor resection. The median cavity radiosurgery volume was 9.1 ml (range, 0.6-39.9 ml). The median margin and maximum radiation dose were 16 and 32 Gy, respectively.
Local control at the resection site was achieved in 73% of patients at a median follow-up period of 13 months. No variable significantly affected local control. New remote brain metastases occurred in 54% of the patients. Symptomatic radiation effect was seen in 5.4% of the patients. The median survival was 13 months after radiosurgery (range, 2-56 mo).
Tumor bed radiosurgery provides effective local control of the tumor after resection in most patients. These preliminary data support radiosurgery after resection rather than traditional radiation therapy.
脑转移瘤切除术后辅助放疗可降低局部复发风险。全脑放疗可能会给脑转移瘤长期存活者带来显著的神经毒性。本回顾性研究评估肿瘤床立体定向放射外科作为脑转移瘤初次切除术后预防局部复发的一种替代放疗方法的作用。
40例患者在两个不同的学术医学中心接受了脑转移瘤切除术后的肿瘤床放射外科治疗。中位年龄为59.5岁。20例患者（67.5%）有单个转移瘤。80%的患者切除完全，20%的患者切除部分。在进行放射外科治疗时，57.5%的患者全身疾病处于活动期，32.5%处于非活动期，10%处于缓解期。中位卡诺夫斯基功能状态评分80%（范围60 - 100%）。放射外科治疗在肿瘤切除后中位4周进行。中位瘤腔放射外科治疗体积为9.1 ml（范围0.6 - 39.9 ml）。中位边缘剂量和最大放射剂量分别为16 Gy和32 Gy。
在中位随访期13个月时，73%的患者在切除部位实现了局部控制。没有变量对局部控制有显著影响。54%的患者出现了新的远处脑转移。5.4%的患者出现了有症状的放射效应。放射外科治疗后中位生存期为13个月（范围2 - 56个月）。
肿瘤床放射外科在大多数患者切除术后能有效实现肿瘤的局部控制。这些初步数据支持切除术后进行放射外科治疗而非传统放疗。
