Ojerholm Eric, Lee John Y K, Kolker James, Lustig Robert, Dorsey Jay F, Alonso-Basanta Michelle
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Cancer Med. 2014 Jun;3(3):565-71. doi: 10.1002/cam4.206. Epub 2014 Feb 10.
Data on stereotactic radiosurgery (SRS) for four or more metastases are limited. Existing studies are confounded by significant proportions of patients receiving prior whole-brain radiation therapy (WBRT) or concurrent WBRT with SRS. Furthermore, published results disagree about the impact of tumor volume on overall survival. A retrospective review identified 38 patients without prior intracranial radiation or surgery who received Gamma Knife (GK) as sole treatment to ≥4 brain metastases in a single session. Twenty-eight cases with follow-up imaging were analyzed for intracranial progression. Prognostic factors were examined by univariate (log-rank test) and multivariate (Cox proportional hazards model) analyses. Common primary tumors were non-small cell lung (45%), melanoma (37%), and breast (8%). Cases were recursive partitioning analysis class II (94%) or III (6%). Patients harbored a median five tumors (range 4-12) with median total tumor volume of 1.2 cc. A median dose of 21 Gy was prescribed to the 50% isodose line. Patients survived a median 6.7 months from GK. Local treatment failure occurred in one case (4%) and distant failure in 22 (79%). On multivariate analysis, total tumor volume ≥3 cc was significantly associated with distant failure and worsened overall survival (P = 0.042 and 0.040). Fourteen patients (37%) underwent salvage WBRT at a median 10.3 months from GK and seven patients received repeat GK. GK as sole initial treatment for four or more simultaneous metastases spares some patients WBRT and delays it for others. Increased total tumor volume (≥3 cc) is significantly associated with worsened overall survival.
关于立体定向放射外科治疗（SRS）四个或更多转移瘤的数据有限。现有研究因接受过全脑放疗（WBRT）或同时接受WBRT与SRS的患者比例过高而受到混淆。此外，已发表的结果在肿瘤体积对总生存期的影响方面存在分歧。一项回顾性研究确定了38例未接受过颅内放疗或手术的患者，他们在单次治疗中接受伽玛刀（GK）作为≥4个脑转移瘤的唯一治疗。对28例有随访影像学检查的病例进行颅内进展分析。通过单因素（对数秩检验）和多因素（Cox比例风险模型）分析来研究预后因素。常见的原发肿瘤为非小细胞肺癌（45%）、黑色素瘤（37%）和乳腺癌（8%）。病例为递归分区分析II类（94%）或III类（6%）。患者的肿瘤中位数为5个（范围4 - 12个），总肿瘤体积中位数为1.2立方厘米。50%等剂量线的处方中位剂量为21 Gy。患者从GK治疗后存活的中位数为6.7个月。局部治疗失败1例（4%），远处失败22例（79%）。多因素分析显示，总肿瘤体积≥3立方厘米与远处失败和总生存期恶化显著相关（P = 0.042和0.040）。14例患者（37%）在距GK治疗中位数10.3个月时接受了挽救性WBRT，7例患者接受了重复GK治疗。GK作为四个或更多同时发生转移瘤的唯一初始治疗，使一些患者无需接受WBRT，并使另一些患者的WBRT延迟。总肿瘤体积增加（≥3立方厘米）与总生存期恶化显著相关。
