Nath Sameer K, Sheridan Alison D, Rauch Philipp J, Yu James B, Minja Frank J, Vortmeyer Alexander O, Chiang Veronica L
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA,
J Neurooncol. 2014 Apr;117(2):303-10. doi: 10.1007/s11060-014-1389-2. Epub 2014 Feb 7.
Brain metastases treated with stereotactic radiosurgery may show delayed enlargement on post-treatment imaging that is of ambiguous etiology. Histopathologic interpretation of brain specimens is often challenging due to the presence of significant radiation effects admixed with irradiated residual tumor of indeterminate viability. The purpose of this study was to assess the impact of histologic findings on clinical outcomes following resection of these lesions. Between 2004 and 2010, 690 patients with brain metastases were enrolled in a prospective gamma knife data repository, and lesions requiring excision were identified. Tissue specimens were divided into four groups based on the ratio of treatment related inflammatory changes (TRIC) to tumor cells, and subsequently patient outcomes were assessed. Of 2,583 metastases treated, 36 were excised due to symptomatic enlargement. Only TRIC, without residual evidence of tumor, was seen in 36 % (13/36) of specimens. Resection of these lesions resulted in 100 % local control in follow-up. Of the remaining 23 lesions that contained any viable-appearing tumor within the resected specimen, 8 recurred after resection. Lesions that enlarged in the first 6 months were more likely to contain higher amounts of residual tumor cells. Patients with even <2 % tumors cells on excision had significantly worse local control (75 vs. 100 %, p = 0.024) and survival (HR 0.27, p = 0.029) compared with those patients with exclusively TRIC. In summary, our findings underscore the importance of surgically obtaining tissue in a method that facilitates complete lesional interpretive histology in order to accurately guide ongoing patient management.
采用立体定向放射外科治疗的脑转移瘤在治疗后的影像学检查中可能会出现延迟增大，其病因尚不明确。由于存在明显的放射效应，且与无法确定存活情况的照射后残留肿瘤混合在一起，对脑标本进行组织病理学解释往往具有挑战性。本研究的目的是评估组织学结果对这些病变切除后临床结局的影响。2004年至2010年期间，690例脑转移瘤患者被纳入一个前瞻性伽玛刀数据库，并确定了需要切除的病变。根据治疗相关炎症变化（TRIC）与肿瘤细胞的比例，将组织标本分为四组，随后评估患者的结局。在接受治疗的2583个转移瘤中，36个因症状性增大而被切除。在36%（13/36）的标本中仅观察到TRIC，没有肿瘤残留证据。切除这些病变后，随访中局部控制率为100%。在切除标本中含有任何有存活迹象肿瘤的其余23个病变中，8个在切除后复发。在最初6个月内增大的病变更可能含有较高数量的残留肿瘤细胞。与仅存在TRIC的患者相比，切除时肿瘤细胞含量即使<2%的患者局部控制情况（75%对100%，p = 0.024）和生存率（HR 0.27，p = 0.029）明显更差。总之，我们的研究结果强调了以一种有助于对病变进行完整解释性组织学检查的方法手术获取组织的重要性，以便准确指导对患者的持续管理。
