Kano Hideyuki, Kondziolka Douglas, Zorro Oscar, Lobato-Polo Javier, Flickinger John C, Lunsford L Dade
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
J Neurosurg. 2009 Oct;111(4):825-31. doi: 10.3171/2009.4.JNS09246.
Radiosurgery for brain metastasis fails in some patients, who require further surgical care. In this paper the authors' goal was to evaluate prognostic factors that correlate with the survival of patients who require a resection of a brain metastasis after stereotactic radiosurgery (SRS).
During the last 14 years when surgical navigation systems were routinely available, the authors identified 58 patients who required resection for various brain metastases after SRS. The median patient age was 54 years. Prior adjuvant treatment included whole-brain radiation therapy alone (17 patients), chemotherapy alone (9 patients), both radiotherapy and chemotherapy (10 patients), and prior resection before SRS (8 patients). The median target volumes at the time of SRS and resection were 7.7 cm(3) (range 0.5-24.9 cm(3)) and 15.5 cm(3) (range 1.3-81.2 cm(3)), respectively.
At a median follow-up of 7.6 months, 8 patients (14%) were living and 50 patients (86%) had died. The survival after surgical removal was 65, 30, and 16% at 6, 12, and 24 months, respectively (median survival after resection 7.7 months). The local tumor control rate after resection was 71, 62, and 43% at 6, 12, and 24 months, respectively. A univariate analysis revealed that patient preoperative recursive partitioning analysis classification, Karnofsky Performance Scale status, systemic disease status, and the interval between SRS and resection were factors associated with patient survival. The mortality and morbidity rates of resection were 1.7 and 6.9%, respectively.
In patients with symptomatic mass effect after radiosurgery, resection may be warranted. Patients who had delayed local progression after SRS (> 3 months) had the best outcomes after resection.
部分接受脑转移瘤放射外科治疗的患者治疗失败，需要进一步的手术治疗。本文作者的目的是评估与立体定向放射外科治疗（SRS）后需要切除脑转移瘤的患者生存率相关的预后因素。
在过去14年手术导航系统常规可用期间，作者确定了58例SRS后因各种脑转移瘤需要切除的患者。患者中位年龄为54岁。先前的辅助治疗包括单纯全脑放疗（17例患者）、单纯化疗（9例患者）、放疗和化疗联合（10例患者）以及SRS前的先前切除术（8例患者）。SRS和切除时的中位靶体积分别为7.7 cm³（范围0.5 - 24.9 cm³）和15.5 cm³（范围1.3 - 81.2 cm³）。
中位随访7.6个月时，8例患者（14%）存活，50例患者（86%）死亡。手术切除后的6、12和24个月生存率分别为65%、30%和16%（切除后的中位生存期为7.7个月）。切除后的局部肿瘤控制率在6、12和24个月时分别为71%、62%和43%。单因素分析显示，患者术前递归分区分析分类、卡氏功能状态评分、全身疾病状态以及SRS与切除之间的间隔时间是与患者生存相关的因素。切除的死亡率和发病率分别为1.7%和6.9%。
对于放射外科治疗后出现症状性占位效应的患者，可能有必要进行切除。SRS后局部进展延迟（>3个月）的患者切除后预后最佳。
