Swinson Bradley M, Friedman William A
Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA.
Neurosurgery. 2008 May;62(5):1018-31; discussion 1031-2. doi: 10.1227/01.neu.0000325863.91584.09.
To review one of the largest single-institution experiences treating metastatic brain disease with stereotactic radiosurgery.
We performed a retrospective analysis of 619 patients who underwent linear accelerator-based stereotactic radiosurgery for 1569 brain metastases between May 1989 and February 2006. Patient characteristics and treatment parameters were obtained prospectively. Patients were followed up at regular intervals clinically and with imaging studies to document local control, regional control, and survival. Cox proportional hazards analysis was performed using SAS version 9.1 software (SAS Institute, Cary, NC).
Median actuarial survival was 7.9 months. 1- and 2-year actuarial survival probabilities were 0.36 and 0.14, respectively. Radiation Therapy Oncology Group Recursive Partitioning Analysis Class I or II was associated with improved survival, but the difference between the two was insignificant. Female sex, younger age, higher Karnofsky performance status, controlled primary tumor, absence of systemic metastases, asynchronous presentation of brain metastasis, fewer brain metastases, smaller total volume of brain metastases, surgery prior to radiosurgery, and multiple radiosurgical treatments were also associated with improved survival. Melanoma metastasis was associated with impaired survival. Local control was achieved in 84.3% of all lesions treated. 1- and 2-year actuarial local control probabilities were 0.82 and 0.72, respectively. Whole brain radiation therapy prior to radiosurgery was associated with improved regional control.
Linear accelerator-based stereotactic radiosurgery is a safe and effective treatment for patients with metastatic brain tumors. Selection of patients who are likely to benefit most from radiosurgery is complex and treatment decisions should be based on the entire clinical picture.
回顾在单一机构采用立体定向放射外科治疗转移性脑疾病的最大规模经验之一。
我们对1989年5月至2006年2月期间接受基于直线加速器的立体定向放射外科治疗1569个脑转移瘤的619例患者进行了回顾性分析。前瞻性获取患者特征和治疗参数。定期对患者进行临床随访和影像学检查，以记录局部控制、区域控制和生存情况。使用SAS 9.1版软件（SAS Institute，北卡罗来纳州卡里）进行Cox比例风险分析。
精算中位生存期为7.9个月。1年和2年精算生存概率分别为0.36和0.14。放射治疗肿瘤学组递归分区分析I类或II类与生存期改善相关，但两者之间差异不显著。女性、年龄较轻、卡氏功能状态较高、原发肿瘤得到控制、无全身转移、脑转移瘤呈异步表现、脑转移瘤数量较少、脑转移瘤总体积较小、在立体定向放射外科治疗前接受手术以及多次立体定向放射外科治疗也与生存期改善相关。黑色素瘤转移与生存期受损相关。所有治疗的病灶中84.3%实现了局部控制。1年和2年精算局部控制概率分别为0.82和0.72。在立体定向放射外科治疗前进行全脑放射治疗与区域控制改善相关。
基于直线加速器的立体定向放射外科是治疗转移性脑肿瘤患者的一种安全有效的方法。选择最可能从放射外科治疗中获益的患者很复杂，治疗决策应基于整个临床情况。
