Department of Neurosurgery, The Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA.
Int J Radiat Oncol Biol Phys. 2010 Apr;76(5):1486-92. doi: 10.1016/j.ijrobp.2009.03.028. Epub 2009 Jul 18.
The objective of this study was to report our experience with stereotactic radiosurgery performed with the Gamma Knife (GK) in the treatment of patients with brain metastases and to compare survival for those treated with radiosurgery alone with survival for those treated with radiosurgery and whole-brain radiotherapy.
Prospectively collected demographic and clinical characteristics and treatment and survival data on 237 patients with intracranial metastases who underwent radiosurgery with the GK between 2003 and 2007 were reviewed. Kaplan-Meier and Cox proportional hazards regression analyses were used to compare survival by demographic and clinical characteristics and treatment.
The mean age of the patient population was 56 years. The most common tumor histologies were non-small-cell lung carcinoma (34.2%) and breast cancer (13.9%). The median overall survival time was 8.5 months from the time of treatment. The median survival times for patients with one, two/three, and four or more brain metastases were 8.5, 9.4, and 6.7 months, respectively. Patients aged 65 years or greater and those aged less than 65 years had median survival times of 7.8 and 9 months, respectively (p = 0.008). The Karnofsky Performance Score (KPS) at the time of treatment was a significant predictor of survival: those patients with a KPS of 70 or less had a median survival of 2.9 months compared with 10.3 months (p = 0.034) for those with a KPS of 80 or greater. There was no statistically significant difference in survival between patients treated with radiosurgery alone and those treated with radiosurgery plus whole-brain radiotherapy.
Radiosurgery with the GK is an efficacious treatment modality for brain metastases. A KPS greater than 70, histology of breast cancer, smaller tumor volume, and age less than 65 years were associated with a longer median survival in our study.
本研究旨在报告我们应用伽玛刀（GK）立体定向放射外科治疗脑转移瘤患者的经验，并比较单纯放射外科治疗与放射外科联合全脑放疗治疗患者的生存情况。
回顾性收集了 2003 年至 2007 年间 237 例颅内转移瘤患者接受 GK 放射外科治疗的人口统计学和临床特征、治疗和生存数据。采用 Kaplan-Meier 法和 Cox 比例风险回归分析比较了不同人口统计学和临床特征及治疗方法的生存情况。
患者的平均年龄为 56 岁。最常见的肿瘤组织学类型是非小细胞肺癌（34.2%）和乳腺癌（13.9%）。从治疗开始的中位总生存时间为 8.5 个月。单发、2/3 个和 4 个或更多脑转移瘤的患者中位生存时间分别为 8.5、9.4 和 6.7 个月。年龄≥65 岁和年龄＜65 岁的患者中位生存时间分别为 7.8 和 9 个月（p = 0.008）。治疗时 Karnofsky 表现状态（KPS）评分是生存的显著预测因素：KPS 评分≤70 分的患者中位生存时间为 2.9 个月，而 KPS 评分≥80 分的患者中位生存时间为 10.3 个月（p = 0.034）。单纯放射外科治疗与放射外科联合全脑放疗治疗患者的生存无统计学差异。
GK 立体定向放射外科是治疗脑转移瘤的有效方法。在我们的研究中，KPS 评分＞70、乳腺癌组织学、肿瘤体积较小和年龄＜65 岁与中位生存时间延长相关。
