Patchell R A, Tibbs P A, Walsh J W, Dempsey R J, Maruyama Y, Kryscio R J, Markesbery W R, Macdonald J S, Young B
Department of Surgery (Neurosurgery Division), University of Kentucky Medical Center, Lexington 40536-0084.
N Engl J Med. 1990 Feb 22;322(8):494-500. doi: 10.1056/NEJM199002223220802.
To assess the efficacy of surgical resection of brain metastases from extracranial primary cancer, we randomly assigned patients with a single brain metastasis to either surgical removal of the brain tumor followed by radiotherapy (surgical group) or needle biopsy and radiotherapy (radiation group). Forty-eight patients (25 in the surgical group and 23 in the radiation group) formed the study group; 6 other patients (11 percent) were excluded from the study because on biopsy their lesions proved to be either second primary tumors or inflammatory or infectious processes. Recurrence at the site of the original metastasis was less frequent in the surgical group than in the radiation group (5 of 25 [20 percent] vs. 12 of 23 [52 percent]; P less than 0.02). The overall length of survival was significantly longer in the surgical group (median, 40 weeks vs. 15 weeks in the radiation group; P less than 0.01), and the patients treated with surgery remained functionally independent longer (median, 38 weeks vs. 8 weeks in the radiation group; P less than 0.005). We conclude that patients with cancer and a single metastasis to the brain who receive treatment with surgical resection plus radiotherapy live longer, have fewer recurrences of cancer in the brain, and have a better quality of life than similar patients treated with radiotherapy alone.
为评估外科手术切除颅外原发性癌症脑转移瘤的疗效，我们将患有单个脑转移瘤的患者随机分为两组，一组接受脑肿瘤手术切除后放疗（手术组），另一组接受针吸活检及放疗（放疗组）。48例患者（手术组25例，放疗组23例）组成研究组；另有6例患者（11%）被排除在研究之外，因为活检显示他们的病变为第二原发性肿瘤或炎症或感染性病变。手术组原转移部位的复发率低于放疗组（25例中有5例[20%]，而放疗组23例中有12例[52%]；P<0.02）。手术组的总生存期明显更长（中位数，40周，而放疗组为15周；P<0.01），接受手术治疗的患者功能独立时间也更长（中位数，38周，而放疗组为8周；P<0.005）。我们得出结论，与仅接受放疗的类似患者相比，患有癌症且有单个脑转移瘤并接受手术切除加放疗治疗的患者生存期更长，脑内癌症复发更少，生活质量更高。
