Molenaar Richard, Wiggenraad Ruud, Verbeek-de Kanter Antoinette, Walchenbach Rob, Vecht Charles
Neuro-Oncology Unit, Dept. of Neurology, Medical Center The Hague, The Hague, The Netherlands.
Br J Neurosurg. 2009 Apr;23(2):170-8. doi: 10.1080/02688690902755613.
The aim of this study is to analyse the efficacy of linear accelerator stereotactic radiosurgery (SRS) on prognostic factors, local control rate and survival in patients with brain metastasis. Patients with either a single metastasis or up to 4 multiple brain metastases with a maximum tumour diameter of 40 mm for each tumour and a Karnofsky Performance Status (KPS) > or = 70 were eligible for SRS. SRS was applied to 150 lesions in 86 consecutive patients with a median age of 60 years (median 1 and mean 1.7 lesions per patient, mean KPS 86). Median overall survival was 6.2 months after SRS and 9.7 months from diagnosis of brain metastasis. Multivariate analysis revealed that a KPS of 90 or more (p = 0.009) and female sex (p = 0.003) were associated with a longer survival. Radiation dose < or = 15 Gy (p = 0.017) and KPS < 90 (p = 0.013) were independent predictors of a shorter time to local failure. Five patients showed evidence of radionecrosis with a median survival of 14.8 months. Addition of WBRT neither led to improvement of survival nor to improvement of local control. Improved local control following SRS for brain metastases was associated with KPS > or =90, a radiation dose > 15 Gy and a PTV < 13 cc. The potential of hypofractionated stereotactic radiotherapy (SRT) for brain metastases of larger volume warrants further study.
本研究的目的是分析直线加速器立体定向放射外科（SRS）对脑转移瘤患者预后因素、局部控制率和生存率的疗效。单个转移瘤或最多4个多发脑转移瘤、每个肿瘤最大直径为40 mm且卡氏功能状态（KPS）≥70的患者符合SRS治疗条件。对86例连续患者的150个病灶进行了SRS治疗，患者中位年龄为60岁（中位每人1个病灶，平均每人1.7个病灶，平均KPS为86）。SRS治疗后中位总生存期为6.2个月，从脑转移瘤诊断起为9.7个月。多因素分析显示，KPS≥90（p = 0.009）和女性（p = 0.003）与较长生存期相关。放射剂量≤15 Gy（p = 0.017）和KPS＜90（p = 0.013）是局部失败时间较短的独立预测因素。5例患者出现放射性坏死证据，中位生存期为14.8个月。加用全脑放疗（WBRT）既未改善生存率也未改善局部控制。SRS治疗脑转移瘤后局部控制的改善与KPS≥90、放射剂量＞15 Gy和计划靶体积（PTV）＜13 cc相关。大体积脑转移瘤的低分割立体定向放疗（SRT）潜力值得进一步研究。
