Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Neurosurgery. 2011 Oct;69(4):796-806; discussion 806. doi: 10.1227/NEU.0b013e31821d31de.
Treatment of tumors metastatic to the brainstem with stereotactic radiosurgery (SRS) has not been widely studied.
To identify the effects of SRS on patients with brainstem metastases by assessing duration of local progression-free survival (LPFS) and overall survival.
We retrospectively reviewed clinical data collected from 60 patients undergoing linear accelerator-based SRS for tumors metastatic to the brainstem between August 1994 and December 2007. The LPFS and overall survival were calculated with the Kaplan-Meier method. Prognostic factors were evaluated with the log-rank test and Cox proportional hazards model.
The median age of patients was 61 years (range, 39-85 years); the median treated lesion volume was 1.0 mL (range, 0.1-8.7 mL); and the median SRS dose was 15 Gy (range, 8-18 Gy). The median overall survival interval after SRS was 4 months (95% confidence interval, 3.4-4.9 months); crude local tumor control was 76%; and median LPFS was 5.7 months (95% confidence interval, 3.0-8.4 months). Shorter overall survival was associated with a pretreatment tumor volume ≥4 mL (P < .001) and male sex (P = .03). Shorter LPFS was associated with a pretreatment tumor volume ≥4 mL (P = .008), a melanoma primary tumor (P = .002), and the presence of necrosis in pre-SRS magnetic resonance imaging (P = .04). A Basic Score for Brain Metastases of 2 to 3 vs 1 (P = .007) and a Score Index for Radiosurgery >5 (P = .003) were significantly associated with longer survival. Twelve patients (20%) developed SRS-related complications.
Stereotactic radiosurgery provides noninvasive treatment and favorable local tumor control for patients with brainstem metastases.
采用立体定向放射外科（SRS）治疗脑干转移瘤的研究并不广泛。
通过评估局部无进展生存期（LPFS）和总生存期，确定 SRS 对脑干转移瘤患者的疗效。
我们回顾性分析了 1994 年 8 月至 2007 年 12 月期间 60 例接受基于直线加速器的 SRS 治疗的脑干转移瘤患者的临床资料。采用 Kaplan-Meier 法计算 LPFS 和总生存期。采用对数秩检验和 Cox 比例风险模型评估预后因素。
患者的中位年龄为 61 岁（范围 39-85 岁）；中位治疗病变体积为 1.0 mL（范围 0.1-8.7 mL）；中位 SRS 剂量为 15 Gy（范围 8-18 Gy）。SRS 后中位总生存时间为 4 个月（95%置信区间，3.4-4.9 个月）；粗局部肿瘤控制率为 76%；中位 LPFS 为 5.7 个月（95%置信区间，3.0-8.4 个月）。总生存时间较短与治疗前肿瘤体积≥4 mL（P<0.001）和男性（P=0.03）相关。LPFS 较短与治疗前肿瘤体积≥4 mL（P=0.008）、黑色素瘤原发病灶（P=0.002）和 SRS 前磁共振成像存在坏死（P=0.04）相关。基线脑转移评分（BSM）为 2-3 分与 1 分（P=0.007）和放射外科评分指数（RSI）>5 分（P=0.003）与生存时间延长显著相关。12 例患者（20%）发生与 SRS 相关的并发症。
立体定向放射外科为脑干转移瘤患者提供了一种非侵入性的治疗方法，并能有效控制局部肿瘤。
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