Petr Michael J, McPherson Christopher M, Breneman John C, Warnick Ronald E
Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA.
J Neurooncol. 2009 May;92(3):393-400. doi: 10.1007/s11060-009-9868-6. Epub 2009 Apr 9.
In this retrospective study, we evaluate the efficacy of surgical resection and I-125 seeds, without upfront whole brain radiotherapy (WBRT), for newly diagnosed single brain metastasis. About 40 women and 32 men underwent gross total resection and placement of permanent low-activity I-125 seeds at our institution (1997-2007). Primary systemic cancer sites varied. At follow-up (median 16 months), local control rate was 93%. Distant brain failures occurred in 23 (32%) patients: 5 patients within 3 months and 18 patients >3 months; brain failure underwent further treatment (i.e., radiosurgery in 13, WBRT in 5, surgical resection with I-125 seeds in 2). Four patients developed radiation necrosis. All 72 patients had stable or improved Karnofsky Performance Score at 1 month after surgery. Median actuarial survival rate was 14 months; 2-year survival rate was 27%. Permanent I-125 brachytherapy at initial operation without WBRT provided excellent local control. 67 patients (93%) never required WBRT, thus avoiding potential long-term radiation-induced neurotoxicity.
在这项回顾性研究中，我们评估了手术切除联合I-125粒子植入（不进行前期全脑放疗）对新诊断的单发脑转移瘤的疗效。在我们机构（1997 - 2007年），约40名女性和32名男性接受了全切除并植入永久性低活度I-125粒子。原发系统癌症部位各不相同。随访（中位时间16个月）时，局部控制率为93%。23例（32%）患者发生远处脑转移：5例在3个月内，18例在3个月后；发生脑转移的患者接受了进一步治疗（即13例行放射外科治疗，5例行全脑放疗，2例行手术切除联合I-125粒子植入）。4例患者发生放射性坏死。所有72例患者术后1个月时卡氏功能状态评分保持稳定或有所改善。中位精算生存率为14个月；2年生存率为27%。初始手术时采用永久性I-125近距离放疗且不进行全脑放疗可实现良好的局部控制。67例（93%）患者从未需要全脑放疗，从而避免了潜在的长期放射性神经毒性。
