DeAngelis L M, Mandell L R, Thaler H T, Kimmel D W, Galicich J H, Fuks Z, Posner J B
Department of Neurology, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, New York.
Neurosurgery. 1989 Jun;24(6):798-805. doi: 10.1227/00006123-198906000-00002.
To assess the value of whole brain radiotherapy (WBRT) after complete resection of a single brain metastasis we reviewed the records of 98 patients who had elective craniotomy between 1978 and 1985. Seventy-nine patients received postoperative WBRT (Group A) and 19 patients no radiotherapy (RT) (Group B). Neurological relapse was designated as local (i.e., at the site of the original metastasis) or distant (i.e., elsewhere in the brain). Postoperative WBRT significantly prolonged the time to any neurological relapse (P = 0.034) with a 1-year recurrence rate of 22% in Group A and 46% in Group B patients; however, it did not specifically control either local or distant cerebral recurrence. Recurrence of metastatic brain disease was not affected by location of the original lesion; however, meningeal relapse occurred in 38% of cerebellar lesions, but only in 4.7% of supratentorial metastases (P = 0.003). The total radiation dose or fractionation scheme of RT did not affect survival nor time to neurological relapse. The median survival was 20.6 and 14.4 months for Groups A and B, respectively (not statistically different). Forty-eight percent of Group A and 47% of Group B patients survived for 1 year or longer; however, 11% of patients who had received RT and survived 1 year developed severe radiation-induced dementia. All patients with radiation-related cerebral damage received hypo-fractionated RT with high daily fractions as commonly designed for rapid palliation of macroscopic brain metastases.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估全脑放疗（WBRT）在单个脑转移瘤完全切除后的价值，我们回顾了1978年至1985年间接受择期开颅手术的98例患者的记录。79例患者接受了术后WBRT（A组），19例患者未接受放疗（B组）。神经复发分为局部复发（即原发转移部位）或远处复发（即脑内其他部位）。术后WBRT显著延长了至任何神经复发的时间（P = 0.034），A组患者1年复发率为22%，B组为46%；然而，它并未特异性地控制局部或远处脑复发。转移性脑疾病的复发不受原发灶位置的影响；然而，38%的小脑病变发生脑膜复发，而幕上转移仅为4.7%（P = 0.003）。放疗的总剂量或分割方案不影响生存率或至神经复发的时间。A组和B组的中位生存期分别为20.6个月和14.4个月（无统计学差异）。A组48%和B组47%的患者存活1年或更长时间；然而，接受放疗并存活1年的患者中有11%发生了严重的放射性痴呆。所有发生放射性脑损伤的患者均接受了低分割放疗，每日分割剂量高，这是通常为快速缓解肉眼可见的脑转移瘤而设计的。（摘要截断于250字）
