Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):113-20. doi: 10.1016/j.ijrobp.2011.06.1965. Epub 2011 Oct 20.
To determine the efficacy and safety of radiosurgery in patients with large brain metastases treated with radiosurgery.
Eighty patients with large brain metastases (>14 cm(3)) were treated with radiosurgery between 1998 and 2009. The mean age was 59 ± 11 years, and 49 (61.3%) were men. Neurologic symptoms were identified in 77 patients (96.3%), and 30 (37.5%) exhibited a dependent functional status. The primary disease was under control in 36 patients (45.0%), and 44 (55.0%) had a single lesion. The mean tumor volume was 22.4 ± 8.8 cm(3), and the mean marginal dose prescribed was 13.8 ± 2.2 Gy.
The median survival time from radiosurgery was 7.9 months (95% confidence interval [CI], 5.343-10.46), and the 1-year survival rate was 39.2%. Functional improvement within 1-4 months or the maintenance of the initial independent status was observed in 48 (60.0%) and 20 (25.0%) patients after radiosurgery, respectively. Control of the primary disease, a marginal dose of ≥11 Gy, and a tumor volume ≥26 cm(3) were significantly associated with overall survival (hazard ratio, 0.479; p = .018; 95% CI, 0.261-0.880; hazard ratio, 0.350; p = .004; 95% CI, 0.171-0.718; hazard ratio, 2.307; p = .006; 95% CI, 1.274-4.180, respectively). Unacceptable radiation-related toxicities (Radiation Toxicity Oncology Group central nervous system toxicity Grade 3, 4, and 5 in 7, 6, and 2 patients, respectively) developed in 15 patients (18.8%).
Radiosurgery seems to have a comparable efficacy with surgery for large brain metastases. However, the rate of radiation-related toxicities after radiosurgery should be considered when deciding on a treatment modality.
确定放射外科治疗大体积脑转移瘤（＞14cm³）患者的疗效和安全性。
1998 年至 2009 年间，80 例大体积脑转移瘤（＞14cm³）患者接受放射外科治疗。患者平均年龄 59±11 岁，49 例（61.3%）为男性。77 例（96.3%）患者存在神经症状，30 例（37.5%）有依赖性功能状态。36 例（45.0%）患者原发病灶得到控制，44 例（55.0%）为单发病灶。肿瘤平均体积 22.4±8.8cm³，处方边缘剂量为 13.8±2.2Gy。
放射外科治疗后中位生存时间为 7.9 个月（95%置信区间：5.343-10.46），1 年生存率为 39.2%。放射外科治疗后 1-4 个月内功能改善或保持初始独立状态的患者分别为 48 例（60.0%）和 20 例（25.0%）。控制原发病灶、边缘剂量≥11Gy 和肿瘤体积≥26cm³与总生存时间显著相关（风险比分别为 0.479，p=.018；95%置信区间分别为 0.261-0.880；风险比分别为 0.350，p=.004；95%置信区间分别为 0.171-0.718；风险比分别为 2.307，p=.006；95%置信区间分别为 1.274-4.180）。15 例（18.8%）患者出现不可接受的放射性毒性反应（放射治疗肿瘤学组中枢神经系统毒性 3 级、4 级和 5 级分别为 7、6 和 2 例）。
放射外科治疗大体积脑转移瘤的疗效与手术相当。然而，在选择治疗方式时，应考虑放射外科治疗后放射性毒性反应的发生率。
