Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
Cancer. 2011 Jun 1;117(11):2505-12. doi: 10.1002/cncr.25707. Epub 2010 Dec 14.
It is largely unknown to what extent new oncologic treatment options have improved survival of patients with brain metastasis in recent decades. Therefore, a multi-institutional time-staggered analysis was performed.
Two cohorts of 103 patients each were analyzed, one treated between 2005 and 2009 and the other between 1983 and 1989, ie, approximately 20 years earlier. Stratified analyses by prognostic groups were also performed (graded prognostic assessment [GPA] and Radiation Therapy Oncology Group recursive partitioning analysis [RTOG-RPA]).
Patterns of care have changed significantly. Contemporary patients received focal treatments such as stereotactic radiosurgery and surgical resection far more frequently. Furthermore, systemic treatment was used more often in contemporary patients, both before and after diagnosis of brain metastasis. Improved survival was observed in the contemporary cohort (P = .03). The 1-year survival rate increased from 15% (95% confidence interval [CI], 7%-25%) to 34% (95% CI, 25%-44%). However, this improvement was largely driven by patients with favorable prognostic features. More than 40% of the patients still belong to unfavorable prognostic groups with limited median survival and little improvement.
Contemporary patients were managed on a much more individualized basis, requiring multidisciplinary case discussion and thorough assessment of prognostic features. Progress has been made, but the overall outcome needs to be improved further. Avoiding overtreatment in patients with poor prognosis is as important as aggressive treatment in patients who might survive for several years.
近几十年来，新的肿瘤治疗方案在多大程度上提高了脑转移患者的生存率尚不清楚。因此，进行了一项多机构的时间交错分析。
分析了两组各 103 例患者，一组患者治疗时间为 2005 年至 2009 年，另一组为 1983 年至 1989 年，即大约 20 年前。还按预后组进行了分层分析（分级预后评估[GPA]和放射治疗肿瘤学组递归分区分析[RTOG-RPA]）。
治疗模式发生了显著变化。当代患者更频繁地接受立体定向放射外科和手术切除等局部治疗。此外，当代患者在脑转移诊断前后更频繁地使用系统治疗。当代队列观察到生存改善（P =.03）。1 年生存率从 15%（95%置信区间[CI]，7%-25%）提高到 34%（95% CI，25%-44%）。然而，这种改善主要是由预后良好的患者驱动的。超过 40%的患者仍属于预后不良的组，中位生存时间有限，改善不大。
当代患者的治疗更加个体化，需要多学科病例讨论和对预后特征的全面评估。已经取得了进展，但总体结果需要进一步改善。避免预后不良患者的过度治疗与对可能存活数年的患者的积极治疗同样重要。
