Department of Neurosurgery, Stanford University Medical Center, Stanford, CA 94305-5847, USA.
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):688-93. doi: 10.1016/j.ijrobp.2012.01.028. Epub 2012 Mar 22.
Single-modality treatment of large brain metastases (>2 cm) with whole-brain irradiation, stereotactic radiosurgery (SRS) alone, or surgery alone is not effective, with local failure (LF) rates of 50% to 90%. Our goal was to improve local control (LC) by using multimodality therapy of surgery and adjuvant SRS targeting the resection cavity.
We retrospectively evaluated 97 patients with brain metastases >2 cm in diameter treated with surgery and cavity SRS. Local and distant brain failure (DF) rates were analyzed with competing risk analysis, with death as a competing risk. The overall survival rate was calculated by the Kaplain-Meier product-limit method.
The median imaging follow-up duration for all patients was 10 months (range, 1-80 months). The 12-month cumulative incidence rates of LF, with death as a competing risk, were 9.3% (95% confidence interval [CI], 4.5%-16.1%), and the median time to LF was 6 months (range, 3-17 months). The 12-month cumulative incidence rate of DF, with death as a competing risk, was 53% (95% CI, 43%-63%). The median survival time for all patients was 15.6 months. The median survival times for recursive partitioning analysis classes 1, 2, and 3 were 33.8, 13.7, and 9.0 months, respectively (p = 0.022). On multivariate analysis, Karnofsky Performance Status (≥80 vs. <80; hazard ratio 0.54; 95% CI 0.31-0.94; p = 0.029) and maximum preoperative tumor diameter (hazard ratio 1.41; 95% CI 1.08-1.85; p = 0.013) were associated with survival. Five patients (5%) required intervention for Common Terminology Criteria for Adverse Events v4.02 grade 2 and 3 toxicity.
Surgery and adjuvant resection cavity SRS yields excellent LC of large brain metastases. Compared with other multimodality treatment options, this approach allows patients to avoid or delay whole-brain irradiation without compromising LC.
对于直径大于 2 厘米的大脑部转移瘤，单纯采用全脑放疗、立体定向放射外科（SRS）或手术治疗效果不佳，局部失败（LF）率为 50%至 90%。我们的目标是通过手术联合辅助 SRS 治疗切除腔来提高局部控制率（LC）。
我们回顾性评估了 97 例直径大于 2 厘米的脑转移瘤患者，这些患者接受了手术和腔 SRS 治疗。采用竞争风险分析分析局部和远处脑失败（DF）的发生率，以死亡为竞争风险。通过 Kaplan-Meier 乘积限法计算总生存率。
所有患者的中位影像学随访时间为 10 个月（范围，1-80 个月）。以死亡为竞争风险，12 个月时 LF 的累积发生率为 9.3%（95%置信区间[CI]，4.5%-16.1%），中位 LF 时间为 6 个月（范围，3-17 个月）。以死亡为竞争风险，12 个月时 DF 的累积发生率为 53%（95%CI，43%-63%）。所有患者的中位生存时间为 15.6 个月。递归分区分析分类 1、2 和 3 的中位生存时间分别为 33.8、13.7 和 9.0 个月（p=0.022）。多因素分析显示，Karnofsky 表现状态（≥80 分与＜80 分；风险比 0.54；95%CI 0.31-0.94；p=0.029）和最大术前肿瘤直径（风险比 1.41；95%CI 1.08-1.85；p=0.013）与生存相关。5 例（5%）患者因通用不良事件术语标准 4.02 级 2 级和 3 级毒性需要干预。
手术联合辅助切除腔 SRS 可获得大脑部转移瘤的优异 LC。与其他多种治疗方法相比，该方法可避免或延迟全脑放疗，而不会影响 LC。
