Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan 48202, USA.
Neurosurgery. 2012 Nov;71(5):937-43. doi: 10.1227/NEU.0b013e31826909f2.
The standard treatment of resected brain metastasis is whole-brain radiotherapy (WBRT). To avoid the potential toxicity of WBRT and to improve local control, we have used radiosurgery alone to the surgical cavity.
To demonstrate the rates of local control, new intracranial metastasis, and overall survival using this treatment scheme without WBRT.
Eighty-five consecutive patients with brain metastasis were treated with surgical resection of at least 1 lesion followed by radiosurgery alone to the surgical cavity and any unresected lesions from August 2000 to March 2011. Sixty-eight percent had gross total resections. After surgery, radiosurgery was delivered to the surgical cavity with a 2- to 3-mm margin. The median marginal radiosurgery dose was 16 Gy, and median target volume was 13.96 cm. Follow-up imaging and clinical examination were obtained every 2 to 3 months.
Median follow-up time was 11.2 months. Overall local control was 81.2%. The 6-month, 1-year, and 2-year rates of local control were 88.7%, 81.4%, and 75.7%, respectively. Forty-seven patients (55%) developed new intracranial metastases at a median time of 5.6 months. For the entire population, the rate of new metastases was 32.1%, 58.1%, and 62.9% at 6 months, 1 year, and 2 years, respectively. Median overall survival time was 12.1 months. From initial treatment until death or last follow-up, only 30 patients (35%) received WBRT as salvage treatment.
Radiosurgery to the surgical cavity without WBRT achieved excellent local control of resected brain metastasis. Close imaging follow-up allows early intervention for any new metastasis.
切除脑转移瘤的标准治疗方法是全脑放疗（WBRT）。为了避免 WBRT 的潜在毒性，并提高局部控制率，我们单独使用放射外科手术治疗手术腔。
展示不使用 WBRT 仅用放射外科手术治疗手术腔和任何未切除病变的局部控制率、新颅内转移率和总生存率。
2000 年 8 月至 2011 年 3 月，85 例脑转移瘤患者至少切除 1 个病灶，然后单独进行放射外科手术治疗手术腔和任何未切除的病灶。68%的患者行大体全切除。手术后，在 2 至 3mm 边缘处对手术腔进行放射外科手术治疗。边缘放射外科手术治疗的中位剂量为 16Gy，中位靶体积为 13.96cm。每 2 至 3 个月进行一次随访影像学和临床检查。
中位随访时间为 11.2 个月。总体局部控制率为 81.2%。6 个月、1 年和 2 年的局部控制率分别为 88.7%、81.4%和 75.7%。47 例（55%）患者在中位时间 5.6 个月时出现新的颅内转移。对于整个患者群体，6 个月、1 年和 2 年时的新转移率分别为 32.1%、58.1%和 62.9%。中位总生存时间为 12.1 个月。从初始治疗到死亡或最后一次随访，只有 30 例（35%）患者接受了 WBRT 作为挽救治疗。
不进行 WBRT 而单独对手术腔进行放射外科手术治疗可实现切除脑转移瘤的良好局部控制。密切的影像学随访可早期干预任何新的转移灶。
