Hara Wendy, Tran Phuoc, Li Gordon, Su Zheng, Puataweepong Putipun, Adler John R, Soltys Scott G, Chang Steven D, Gibbs Iris C
Department of Radiation Oncology, Stanford University, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, CA 94305-5847, USA.
Neurosurgery. 2009 Feb;64(2 Suppl):A26-32. doi: 10.1227/01.NEU.0000339118.55334.EA.
To evaluate the efficacy of CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) for patients with brain metastases of malignant melanoma and renal cell carcinoma.
We conducted a retrospective review of all patients treated by image-guided radiosurgery at our institution between March 1999 and December 2005. Sixty-two patients with 145 brain metastases of renal cell carcinoma or melanoma were identified.
The median follow-up period was 10.5 months. Forty-four patients had malignant melanoma, and 18 patients had renal cell carcinoma. The median age was 57 years, and patients were classified as recursive partitioning analysis Class 1 (6 patients), 2 (52 patients) or 3 (4 patients). Thirty-three patients had been treated systemically with either chemotherapy or immunotherapy, and 33 patients were taking corticosteroids at the time of treatment. The mean tumor volume was 1.47 mL (range, 0.02-35.7 mL), and the mean prescribed dose was 20 Gy (range, 14-24 Gy). The median survival after SRS was 8.3 months. Actuarial survival at 6 and 12 months was 57 and 37%, respectively. On multivariate analysis, Karnofsky Performance Scale score (P < 0.01) and previous immunotherapy/clinical trial (P = 0.01) significantly affected overall survival. One-year intracranial progression-free survival was 38%, and local control was 87%. Intracranial control was impacted by whole-brain radiotherapy (P = 0.01), previous chemotherapy (P = 0.01), and control of the primary at the time of SRS (P = 0.02). Surgical resection had no effect on intracranial or local control. Radiographic evidence of radiation necrosis developed in 4 patients (6%).
CyberKnife radiosurgery provided excellent local control with acceptable toxicity in patients with melanoma or renal cell brain metastases. Initial SRS alone appeared to be a reasonable option, as survival was dictated by systemic disease.
评估射波刀（Accuray公司，加利福尼亚州桑尼维尔市）立体定向放射外科（SRS）治疗恶性黑色素瘤和肾细胞癌脑转移患者的疗效。
我们对1999年3月至2005年12月期间在本机构接受图像引导放射外科治疗的所有患者进行了回顾性研究。确定了62例患有145处肾细胞癌或黑色素瘤脑转移的患者。
中位随访期为10.5个月。44例患者患有恶性黑色素瘤，18例患者患有肾细胞癌。中位年龄为57岁，患者被分类为递归分区分析1级（6例）、2级（52例）或3级（4例）。33例患者接受过全身化疗或免疫治疗，33例患者在治疗时正在服用皮质类固醇。平均肿瘤体积为1.47 mL（范围为0.02 - 35.7 mL），平均处方剂量为20 Gy（范围为14 - 24 Gy）。SRS后的中位生存期为8.3个月。6个月和12个月时的精算生存率分别为57%和37%。多因素分析显示，卡诺夫斯基功能状态评分（P < 0.01）和既往免疫治疗/临床试验（P = 0.01）对总生存期有显著影响。1年颅内无进展生存率为38%，局部控制率为87%。全脑放疗（P = 0.01）、既往化疗（P = 0.01）和SRS时原发灶控制情况（P = 0.02）对颅内控制有影响。手术切除对颅内或局部控制无影响。4例患者（6%）出现放射性坏死的影像学证据。
射波刀放射外科对黑色素瘤或肾细胞癌脑转移患者提供了良好的局部控制，且毒性可接受。仅初始SRS似乎是一个合理的选择，因为生存期取决于全身疾病。
