Katsuta Hospital Mito GammaHouse, Hitachi-naka, Ibaraki, Japan.
Int J Radiat Oncol Biol Phys. 2013 Jan 1;85(1):53-60. doi: 10.1016/j.ijrobp.2012.04.018. Epub 2012 May 30.
Little is known about delayed complications after stereotactic radiosurgery in long-surviving patients with brain metastases. We studied the actual incidence and predictors of delayed complications.
This was an institutional review board-approved, retrospective cohort study that used our database. Among our consecutive series of 2000 patients with brain metastases who underwent Gamma Knife radiosurgery (GKRS) from 1991-2008, 167 patients (8.4%, 89 women, 78 men, mean age 62 years [range, 19-88 years]) who survived at least 3 years after GKRS were studied.
Among the 167 patients, 17 (10.2%, 18 lesions) experienced delayed complications (mass lesions with or without cyst in 8, cyst alone in 8, edema in 2) occurring 24.0-121.0 months (median, 57.5 months) after GKRS. The actuarial incidences of delayed complications estimated by competing risk analysis were 4.2% and 21.2% at the 60th month and 120th month, respectively, after GKRS. Among various pre-GKRS clinical factors, univariate analysis demonstrated tumor volume-related factors: largest tumor volume (hazard ratio [HR], 1.091; 95% confidence interval [CI], 1.018-1.154; P=.0174) and tumor volume≤10 cc vs >10 cc (HR, 4.343; 95% CI, 1.444-12.14; P=.0108) to be the only significant predictors of delayed complications. Univariate analysis revealed no correlations between delayed complications and radiosurgical parameters (ie, radiosurgical doses, conformity and gradient indexes, and brain volumes receiving >5 Gy and >12 Gy). After GKRS, an area of prolonged enhancement at the irradiated lesion was shown to be a possible risk factor for the development of delayed complications (HR, 8.751; 95% CI, 1.785-157.9; P=.0037). Neurosurgical interventions were performed in 13 patients (14 lesions) and mass removal for 6 lesions and Ommaya reservoir placement for the other 8. The results were favorable.
Long-term follow-up is crucial for patients with brain metastases treated with GKRS because the risk of complications long after treatment is not insignificant. However, even when delayed complications occur, favorable outcomes can be expected with timely neurosurgical intervention.
对于接受立体定向放射外科治疗后长期存活的脑转移瘤患者，我们对迟发性并发症知之甚少。我们研究了迟发性并发症的实际发生率和预测因素。
这是一项机构审查委员会批准的回顾性队列研究，使用了我们的数据库。在我们连续的 2000 例脑转移瘤患者中，1991 年至 2008 年间接受伽玛刀放射外科治疗（GKRS），其中 167 例（8.4%，89 例女性，78 例男性，平均年龄 62 岁[范围，19-88 岁]）至少在 GKRS 后存活 3 年。
在 167 例患者中，17 例（10.2%，18 个病灶）在 GKRS 后 24.0-121.0 个月（中位 57.5 个月）出现迟发性并发症（有或无囊肿的肿块 8 个，单纯囊肿 8 个，水肿 2 个）。竞争风险分析估计的迟发性并发症的累积发生率分别为 60 个月和 120 个月时的 4.2%和 21.2%。在各种 GKRS 前临床因素中，单因素分析表明肿瘤体积相关因素：最大肿瘤体积（危险比[HR]，1.091；95%置信区间[CI]，1.018-1.154；P=.0174）和肿瘤体积≤10 cc 与>10 cc（HR，4.343；95%CI，1.444-12.14；P=.0108）是迟发性并发症的唯一显著预测因素。单因素分析显示，迟发性并发症与放射外科参数（即放射外科剂量、适形性和梯度指数以及接受>5 Gy 和>12 Gy 的脑体积）之间无相关性。GKRS 后，照射病变区域的延长增强显示为迟发性并发症发展的可能危险因素（HR，8.751；95%CI，1.785-157.9；P=.0037）。对 13 例患者（14 个病灶）进行了神经外科干预，对 6 个病灶进行了肿块切除，对其余 8 个病灶进行了 Ommaya 储液囊放置。结果是有利的。
对于接受 GKRS 治疗的脑转移瘤患者，长期随访至关重要，因为治疗后很长时间出现并发症的风险不容忽视。然而，即使出现迟发性并发症，及时进行神经外科干预也可获得良好的结果。
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