Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Acta Neurochir (Wien). 2013 Mar;155(3):389-97. doi: 10.1007/s00701-013-1619-y. Epub 2013 Jan 17.
Advancements over the past generation have yielded several new treatment options for the management of brain metastases. However, surgical resection (SR) still remains the mainstay of treatment and is performed especially if decompression is required. The goal of this study was to evaluate the role of surgical resection for patients with brain metastases and to find the best indications for SR.
SR as an initial treatment was performed in 157 patients. Among the 157 patients, 109 (69.4 %) and 17 (10.8 %) underwent adjuvant whole-brain radiotherapy and radiosurgery, respectively. Thirty-one (19.7 %) patients did not undergo adjuvant treatment. Overall survival, tumour recurrence, and clinical outcomes were evaluated. The clinical situation was classified based on the recursive partitioning analysis (RPA) class and Karnofsky performance scale (KPS).
The overall median survival was 19.3 months. Median survival according to the extent of surgical resection was 20.4 months after gross total resection (GTR) and 15.1 months after subtotal resection (STR) (P = 0.016). The patients with stable primary extracranial cancer survived longer than patients with synchronous detection of extracranial cancer (P = 0.032). The RPA I class patients showed longer survival than the RPA II class patients (P = 0.047). This difference was more prominent in the GTR group than in the STR group (GTR, P = 0.022; STR, P = 0.075). The KPS score of the GTR group changed from 82.3 to 87.0 and that of the STR group changed from 79.2 to 77.1 (P = 0.001). Adjuvant treatment did not lead to a significant improvement in the survival and clinical outcome.
Surgical resection may accomplish satisfactory outcomes with technical advancement. The best indications for SR for brain metastasis are RPA I class, stable extracranial cancer, and a planned GTR of the tumour. Even with the advancements in adjuvant therapy, surgical resection plays a major role in the management of brain metastasis.
过去几十年的发展为脑转移瘤的治疗带来了多种新的治疗选择。然而，手术切除（SR）仍然是治疗的主要手段，特别是在需要减压的情况下。本研究的目的是评估手术切除在脑转移瘤患者中的作用，并寻找 SR 的最佳适应证。
157 例患者行初始 SR 治疗。157 例患者中，分别有 109 例（69.4%）和 17 例（10.8%）接受了辅助全脑放疗和放射外科治疗，31 例（19.7%）患者未接受辅助治疗。评估总生存期、肿瘤复发和临床结局。根据递归分区分析（RPA）分级和卡氏功能状态评分（KPS）对临床情况进行分类。
总体中位生存期为 19.3 个月。根据手术切除范围的中位生存期为：GTR 后 20.4 个月，STR 后 15.1 个月（P=0.016）。原发颅外肿瘤稳定的患者比同期发现颅外肿瘤的患者生存期更长（P=0.032）。RPA I 级患者的生存时间长于 RPA II 级患者（P=0.047）。这一差异在 GTR 组比 STR 组更为显著（GTR，P=0.022；STR，P=0.075）。GTR 组的 KPS 评分从 82.3 提高到 87.0，STR 组从 79.2 提高到 77.1（P=0.001）。辅助治疗并不能显著改善生存和临床结局。
随着技术的进步，手术切除可能取得令人满意的效果。脑转移瘤 SR 的最佳适应证为 RPA I 级、稳定的颅外肿瘤和计划行肿瘤 GTR。即使辅助治疗有了进展，手术切除在脑转移瘤的治疗中仍起着重要作用。
