Limbrick David D, Lusis Eriks A, Chicoine Michael R, Rich Keith M, Dacey Ralph G, Dowling Joshua L, Grubb Robert L, Filiput Eric A, Drzymala Robert E, Mansur David B, Simpson Joseph R
Department of Neurosurgery, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA.
Surg Neurol. 2009 Mar;71(3):280-8, disucssion 288-9. doi: 10.1016/j.surneu.2007.12.019. Epub 2008 Apr 18.
Patients with limited intracranial metastatic disease traditionally have been treated with surgery followed by WBRT. However, there is growing concern for the debilitating cognitive effects after WBRT in long-term survivors. We present a series of patients treated with surgery followed by SRS, while reserving WBRT as a salvage therapy for disease progression.
Medical records from 15 patients with 1 to 2 cerebral metastases who underwent both resection and SRS were reviewed. Outcome measures included overall survival, survival by RPA class, EOR, local tumor control, progression of intracranial disease, need for WBRT salvage therapy, and COD.
Fifteen patients with cerebral metastases were treated with the combined surgery-SRS paradigm. Eight of the 15 patients (53.3%) were designated RPA class 1, with 6 of 15 (40.0%) in class 2 and 1 of 15 (6.7%) in class 3. Gross total resection was achieved in 12 cases (80.0%). Overall median survival was 20.0 months, with values of 22.0 and 13.0 months for RPA classes 1 and 2, respectively. Local recurrence occurred in 16.7% of those patients with GTR. Six patients (40.0%) went on to receive WBRT at a median of 8.0 months from initial presentation. Twelve patients (80.0%) had died at the completion of the study, and the COD was CNS progression in 33.3%.
Surgical resection combined with SRS is an effective treatment for selected patients with limited cerebral metastatic disease. Survival using this combined treatment was equivalent to or greater than that reported by other studies using surgery + WBRT or SRS + WBRT.
传统上，颅内转移病灶有限的患者接受手术治疗，随后进行全脑放疗（WBRT）。然而，长期存活者接受WBRT后出现使人衰弱的认知影响这一问题日益受到关注。我们报告了一系列接受手术治疗后再行立体定向放射治疗（SRS）的患者，同时将WBRT留作疾病进展时的挽救治疗。
回顾了15例有1至2个脑转移瘤且接受了切除和SRS治疗的患者的病历。结果指标包括总生存期、按递归分区分析（RPA）分级的生存期、切除范围（EOR）、局部肿瘤控制、颅内疾病进展、是否需要WBRT挽救治疗以及死亡原因（COD）。
15例脑转移瘤患者接受了手术联合SRS治疗模式。15例患者中有8例（53.3%）被定为RPA 1级，15例中有6例（40.0%）为2级，15例中有1例（6.7%）为3级。12例（80.0%）实现了大体全切除。总中位生存期为20.0个月，RPA 1级和2级患者的生存期分别为22.0个月和13.0个月。在实现大体全切除的患者中，16.7%出现局部复发。6例患者（40.0%）在初次就诊后中位8.0个月时继续接受WBRT治疗。12例患者（80.0%）在研究结束时死亡，33.3%的死亡原因是中枢神经系统进展。
手术切除联合SRS是治疗部分颅内转移病灶有限患者的有效方法。采用这种联合治疗的生存期与其他使用手术+WBRT或SRS+WBRT的研究报告的生存期相当或更长。
