Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Neurosurgery. 2011 Dec;69(6):1232-9. doi: 10.1227/NEU.0b013e31822b2fdc.
Although whole-brain radiation therapy (WBRT) has been a standard palliative management for brain metastases from renal cell carcinoma, its benefit has been elusive because of radiobiological resistance.
To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from renal cell carcinoma.
We reviewed records from 158 consecutive patients (men = 111, women = 47) who underwent SRS for 531 brain metastases from renal cell carcinoma. The median patient age was 61 years (range, 38-83 years), and the median number of tumors per patient was 1 (range, 1-10). Seventy-nine patients (50%) had solitary brain metastasis. Fifty-seven patients (36%) underwent prior WBRT. The median total tumor volume for each patient was 3.0 cm3 (range, 0.09-47 cm).
The overall survival after SRS was 60%, 38%, and 19% at 6, 12, and 24 months, respectively, with a median survival of 8.2 months. Factors associated with longer survival included younger age, longer interval between primary diagnosis and brain metastases, lower recursive partitioning analysis class, higher Karnofsky performance status, smaller number of brain metastases, and no prior WBRT. Median survival for patients with < 2 brain metastases, higher Karnofsky performance status (> 90), and no prior WBRT was 12 months after SRS. Sustained local tumor control was achieved in 92% of patients. Symptomatic adverse radiation effects occurred in 7%. Overall, 70% of patients improved or remained neurologically stable.
Stereotactic radiosurgery is an especially valuable option for patients with higher Karnofsky performance status and smaller number of brain metastases from renal cell carcinoma.
虽然全脑放疗（WBRT）一直是治疗肾细胞癌脑转移的标准姑息性治疗方法，但由于放射生物学抗性，其疗效仍难以捉摸。
评估立体定向放射外科（SRS）在治疗肾细胞癌脑转移中的作用。
我们回顾了 158 例连续接受 SRS 治疗的 531 例肾细胞癌脑转移患者的记录。患者中位年龄为 61 岁（范围，38-83 岁），每位患者的肿瘤中位数为 1 个（范围，1-10 个）。79 例（50%）患者为单发脑转移。57 例（36%）患者曾接受过 WBRT。每位患者的总肿瘤体积中位数为 3.0cm³（范围，0.09-47cm³）。
SRS 后总的生存率分别为 60%、38%和 19%，在 6、12 和 24 个月时，中位生存时间为 8.2 个月。与生存时间较长相关的因素包括年龄较小、原发诊断与脑转移之间的时间间隔较长、递归分区分析（RPA）分级较低、卡氏功能状态评分（KPS）较高、脑转移灶较少，以及无既往 WBRT。脑转移灶数<2 个、KPS>90 分、无既往 WBRT 的患者 SRS 后中位生存时间为 12 个月。92%的患者获得了持续的局部肿瘤控制。7%的患者出现了症状性放射性不良反应。总体而言，70%的患者神经功能改善或保持稳定。
对于 KPS 较高、脑转移灶较少的肾细胞癌患者，立体定向放射外科是一种特别有价值的选择。
