Nieder Carsten, Marienhagen Kirsten, Dalhaug Astrid, Aandahl Gro, Haukland Ellinor, Pawinski Adam
Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway,
Med Oncol. 2014 Apr;31(4):927. doi: 10.1007/s12032-014-0927-2. Epub 2014 Mar 20.
Most patients with brain metastases have active extracranial disease, which limits survival unless effective systemic therapy can be administered. Available options have increased over the last 5 years. Therefore, we analyzed patient cohorts treated with or without systemic treatment after completion of whole brain radiotherapy (WBRT). This study included retrospective uni- and multivariate analyses of 189 patients. Two landmark analyses requiring minimum survival of 1 or 2 months from start of WBRT were performed. Age and Karnofsky performance status (KPS) requirements were also applied in order to resemble a prospective trial that would limit inclusion to patients with defined baseline characteristics such as adequate KPS. Irrespective of these different statistical scenarios, systemic treatment significantly improved survival. For example, the 2-month landmark analysis with upper age limit and inclusion of patients with KPS > 60 only showed median survival of 9.0 versus 3.7 months, p = 0.001. All patients alive after more than 2 years had received systemic treatment (chemotherapy, endocrine therapy, tyrosine kinase inhibitors or other drugs). After WBRT, systemic treatment is a prerequisite for long-term survival. The exact magnitude of improvement can only be assessed in randomized trials because retrospective cohort studies, even if carefully designed, are not able to correct for all potential imbalances.
大多数脑转移患者存在颅外活动性疾病，除非能给予有效的全身治疗，否则会限制生存期。在过去5年中，可用的治疗选择有所增加。因此，我们分析了全脑放疗（WBRT）完成后接受或未接受全身治疗的患者队列。本研究包括对189例患者的回顾性单因素和多因素分析。进行了两项标志性分析，要求从WBRT开始起至少存活1或2个月。还应用了年龄和卡诺夫斯基性能状态（KPS）要求，以类似于一项前瞻性试验，该试验将纳入范围限制为具有明确基线特征（如足够的KPS）的患者。无论这些不同的统计情况如何，全身治疗均显著改善了生存期。例如，仅纳入年龄上限且KPS>60的患者的2个月标志性分析显示，中位生存期为9.0个月对3.7个月，p = 0.001。所有存活超过2年的患者均接受了全身治疗（化疗、内分泌治疗、酪氨酸激酶抑制剂或其他药物）。WBRT后，全身治疗是长期生存的先决条件。改善的确切程度只能在随机试验中评估，因为回顾性队列研究即使设计得很仔细，也无法校正所有潜在的不平衡。
