Kim Paul K, Ellis Thomas L, Stieber Volker W, McMullen Kevin P, Shaw Edward G, McCoy Thomas P, D'Agostino Ralph B, Bourland J Daniel, DeGuzman Allan F, Ekstrand Kenneth E, Raber Michael R, Tatter Stephen B
Department of Neurosurgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA.
J Neurosurg. 2006 Dec;105 Suppl:75-8. doi: 10.3171/sup.2006.105.7.75.
Salvage treatment of large, symptomatic brain metastases after failure of whole-brain radiotherapy (WBRT) remains challenging. When these lesions require resection, there are few options to lower expected rates of local recurrence at the resection cavity margin. The authors describe their experience in using Gamma Knife surgery (GKS) to target the resection cavity in patients whose tumors had progressed after WBRT.
The authors retrospectively identified 143 patients in whom GKS had been used to target a brain metastasis resection cavity between 2000 and 2005. Seventy-nine of these patients had undergone WBRT prior to resection and GKS. The median patient age was 53 years, and the median prescribed dose was 18 Gy (range 8-24 Gy), with resection cavities of relatively larger volume (> 15 cm3). The GKS dose was prescribed at the 40 to 95% isodose contour (mode 50%). Local recurrence within 1 cm of the treatment volume occurred in four (5.1%) of 79 cases. The median duration of time to local recurrence was 6.1 months (range 2-13 months). The median duration of time to occurrence of distant metastases following GKS of the resection cavity was 10.8 months (range 2-86 months). Carcinomatous meningitis developed in four (5.1%) of 79 cases. Symptomatic radionecrosis requiring surgical treatment occurred in three (3.8%) of 79 cases. The median duration of survival following GKS of the resection cavity was 69.6 weeks. The median 2- and 5-year survival rates were 20.2 and 6.3%, respectively.
When metastases progress after WBRT and require resection, GKS targeting the resection cavity is a viable strategy. In 75 (94.9%) of 79 cases, GKS of the resection cavity in patients in whom WBRT had failed appears to have achieved its goal of local disease control.
全脑放疗（WBRT）失败后，对有症状的大型脑转移瘤进行挽救性治疗仍然具有挑战性。当这些病变需要切除时，降低切除腔边缘局部复发预期率的选择很少。作者描述了他们使用伽玛刀手术（GKS）靶向WBRT后肿瘤进展患者的切除腔的经验。
作者回顾性确定了2000年至2005年间143例使用GKS靶向脑转移瘤切除腔的患者。其中79例患者在切除和GKS之前接受了WBRT。患者中位年龄为53岁，中位处方剂量为18 Gy（范围8 - 24 Gy），切除腔体积相对较大（> 15 cm³）。GKS剂量在40%至95%等剂量线处处方（模式为50%）。79例患者中有4例（5.1%）在治疗体积1 cm范围内出现局部复发。局部复发的中位时间为6.1个月（范围2 - 13个月）。切除腔GKS后远处转移发生的中位时间为10.8个月（范围2 - 86个月）。79例患者中有4例（5.1%）发生癌性脑膜炎。79例患者中有3例（3.8%）出现需要手术治疗的有症状放射性坏死。切除腔GKS后的中位生存期为69.6周。2年和5年中位生存率分别为20.2%和6.3%。
当WBRT后转移瘤进展且需要切除时，靶向切除腔的GKS是一种可行的策略。在79例患者中的75例（94.9%）中，WBRT失败患者切除腔的GKS似乎实现了局部疾病控制的目标。
