伽玛刀手术治疗肾细胞癌脑转移患者中靶向药物对结局的影响。
The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery.
机构信息
Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA.
出版信息
J Neurosurg. 2012 May;116(5):978-83. doi: 10.3171/2012.2.JNS111353. Epub 2012 Mar 2.
OBJECT
Gamma Knife surgery (GKS) has been reported as an effective modality for treating brain metastases from renal cell carcinoma (RCC). The authors aimed to determine if targeted agents such as tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and bevacizumab affect the patterns of failure of RCC after GKS.
METHODS
Between 1999 and 2010, 61 patients with brain metastases from RCC were treated with GKS. A median dose of 20 Gy (range 13-24 Gy) was prescribed to the margin of each metastasis. Kaplan-Meier analysis was used to determine local control, distant failure, and overall survival rates. Cox proportional hazard regression was performed to determine the association between disease-related factors and survival.
RESULTS
Overall survival at 1, 2, and 3 years was 38%, 17%, and 9%, respectively. Freedom from local failure at 1, 2, and 3 years was 74%, 61%, and 40%, respectively. The distant failure rate at 1, 2, and 3 years was 51%, 79%, and 89%, respectively. Twenty-seven percent of patients died of neurological disease. The median survival for patients receiving targeted agents (n = 24) was 16.6 months compared with 7.2 months (n = 37) for those not receiving targeted therapy (p = 0.04). Freedom from local failure at 1 year was 93% versus 60% for patients receiving and those not receiving targeted agents, respectively (p = 0.01). Multivariate analysis showed that the use of targeted agents (hazard ratio 3.02, p = 0.003) was the only factor that predicted for improved survival. Two patients experienced post-GKS hemorrhage within the treated volume.
CONCLUSIONS
Targeted agents appear to improve local control and overall survival in patients treated with GKS for metastastic RCC.
目的
伽玛刀手术（GKS）已被报道为治疗肾细胞癌（RCC）脑转移的有效方法。作者旨在确定是否靶向药物如酪氨酸激酶抑制剂、雷帕霉素靶蛋白抑制剂和贝伐单抗会影响 RCC 患者 GKS 后的失败模式。
方法
1999 年至 2010 年间，61 例 RCC 脑转移患者接受 GKS 治疗。每个转移灶边缘处方的中位剂量为 20Gy（范围 13-24Gy）。采用 Kaplan-Meier 分析确定局部控制、远处失败和总生存率。采用 Cox 比例风险回归分析确定疾病相关因素与生存之间的关系。
结果
总生存率分别为 38%、17%和 9%，1、2 和 3 年无局部失败率分别为 74%、61%和 40%，1、2 和 3 年远处失败率分别为 51%、79%和 89%。27%的患者死于神经疾病。接受靶向治疗（n=24）的患者中位生存时间为 16.6 个月，而未接受靶向治疗（n=37）的患者中位生存时间为 7.2 个月（p=0.04）。接受靶向治疗的患者 1 年无局部失败率为 93%，而未接受靶向治疗的患者为 60%（p=0.01）。多变量分析显示，使用靶向药物（风险比 3.02，p=0.003）是唯一预测生存改善的因素。2 例患者在治疗体积内发生 GKS 后出血。
结论
靶向药物似乎可改善接受 GKS 治疗的转移性 RCC 患者的局部控制和总生存率。
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