University of Miami Miller School of Medicine, University of Virginia, Charlottesville, Virginia 33136, USA.
Neurosurgery. 2013 Mar;72(3):317-25; discussion 325-6. doi: 10.1227/NEU.0b013e31827fcd60.
Optimal postoperative management paradigm for brain metastases remains controversial.
To conduct a systematic review of the literature to understand the role of postoperative stereotactic radiosurgery after resection of brain metastases.
We performed a MEDLINE search of the literature to identify series of patients with brain metastases treated with stereotactic radiosurgery after surgical resection. Outcomes including overall survival, local control, distant intracranial failure, and salvage therapy use were recorded. Patient, tumor, and treatment factors were correlated with outcomes through the use of the Pearson correlation and 2-way Student t test as appropriate.
Fourteen studies involving 629 patients were included. Median survival for all studies was 14 months. Local control was correlated with the median volume treated with radiosurgery (r = -0.766, P < .05) and with the rate of gross total resection (r = .728, P < .03). Mean crude local control was 83%; 1-year local control was 85%. Distant intracranial failure occurred in 49% of cases, and salvage whole-brain radiation therapy was required in 29% of cases. Use of a radiosurgical margin did not lead to increased local control or overall survival.
Our systematic review supports the use of radiosurgery as a safe and effective strategy for adjuvant treatment of brain metastases, particularly when gross total resection has been achieved. With all limitations of comparisons between studies, no increase in local recurrence or decrease in overall survival compared with rates with adjuvant whole-brain radiation therapy was found.
对于脑转移瘤的最佳术后管理模式仍存在争议。
对文献进行系统综述，以了解手术后立体定向放射外科在脑转移瘤治疗中的作用。
我们对文献进行了 MEDLINE 搜索，以确定接受立体定向放射外科治疗的脑转移瘤切除术后患者系列。记录了总生存期、局部控制率、远处颅内失败和挽救性治疗的使用等结果。通过使用 Pearson 相关和 2 路学生 t 检验，将患者、肿瘤和治疗因素与结果相关联。
纳入了 14 项涉及 629 例患者的研究。所有研究的中位生存期为 14 个月。局部控制与放射外科治疗的中位数体积（r = -0.766，P <.05）和大体全切除率（r =.728，P <.03）相关。平均粗局部控制率为 83%；1 年局部控制率为 85%。49%的病例发生远处颅内失败，29%的病例需要全脑放疗挽救。使用放射外科边缘并不能提高局部控制率或总生存率。
我们的系统综述支持将放射外科作为脑转移瘤辅助治疗的一种安全有效的策略，特别是在达到大体全切除的情况下。尽管存在研究之间比较的所有局限性，但与辅助全脑放疗的比率相比，并未发现局部复发率增加或总生存率降低。
