Zairi Fahed, Ouammou Youssef, Le Rhun Emilie, Aboukais Rabih, Blond Serge, Vermandel Maximillien, Deken Valerie, Devos Patrick, Reyns Nicolas
Department of Neurosurgery, Lille University Hospital, Lille, France.
Department of Neurosurgery, Lille University Hospital, Lille, France.
Clin Neurol Neurosurg. 2014 Oct;125:87-93. doi: 10.1016/j.clineuro.2014.07.030. Epub 2014 Jul 27.
Stereotactic radiosurgery (SRS) followed by close follow-up is becoming a popular strategy for the management of brain metastases as cancer patients live longer and late adverse effects of whole brain radiotherapy (WBRT) are increasingly reported. The authors report their experience in consecutively treated patients with limited brain metastases from non-small cell lung cancer (NSCLC), who underwent SRS alone followed by a close follow-up.
This study is the retrospective analysis of prospectively collected data. We included of 89 consecutive patients (80 men; mean age 59.7 years) with a KPS score of 60 or greater, who underwent Gamma Knife SRS for 1-4 metastases, at Lille University Hospital between January 2004 and December 2010. The mean radiation dose was 23.41Gy (range 18-26Gy) and the mean tumour volume was 2.47cm(3) (range 0.3-6.7cm(3)). After treatment, clinical and radiological (MRI) monitoring was scheduled at 2, 4, 8 and 12 months in the first year and at 4-month intervals thereafter.
Overall survival was 70.8% at 1 year and 50% at 2 years. The actuarial local control rate was 91.5% at 1 year and 85.5% at 2 years. Ten of 89 patients experienced a local failure, which required a salvage treatment. The distant brain control rate was 79.2% at 1 year, and 67.1% at 2 years. A total of 25 patients developed new metastases, 10 patients were treated with a new radiosurgical procedure, 12 patients underwent a WBRT while 3 patients developed a leptomeningeal disease. We reported an overall complication rate of 10.1% per patient and 7.8% per treated tumour; all complications were classified grade 1 or 2.
In patients with limited brain metastases from NSCLC, SRS is an effective treatment associated with high local control rate with low morbidity. When performed in isolation, close follow-up is mandatory and radiosurgery can be renewed as salvage treatment for distant brain progression, limiting the use of WBRT.
随着癌症患者生存期延长，全脑放疗（WBRT）的晚期不良反应报告日益增多，立体定向放射外科治疗（SRS）后密切随访正成为脑转移瘤治疗的一种流行策略。作者报告了他们连续治疗非小细胞肺癌（NSCLC）脑转移瘤患者的经验，这些患者仅接受SRS治疗并进行密切随访。
本研究是对前瞻性收集数据的回顾性分析。我们纳入了2004年1月至2010年12月在里尔大学医院连续89例（80例男性；平均年龄59.7岁）KPS评分60分及以上的患者，他们因1 - 4个转移瘤接受了伽玛刀SRS治疗。平均放射剂量为23.41Gy（范围18 - 26Gy），平均肿瘤体积为2.47cm³（范围0.3 - 6.7cm³）。治疗后，第一年在2、4、8和12个月安排临床和影像学（MRI）监测，此后每4个月进行一次。
1年总生存率为70.8%，2年为50%。精算局部控制率1年时为91.5%，2年时为85.5%。89例患者中有10例出现局部复发，需要进行挽救治疗。远处脑转移控制率1年时为79.2%，2年时为67.1%。共有25例患者出现新的转移瘤，10例患者接受了新的放射外科治疗，12例患者接受了WBRT，3例患者发生了软脑膜疾病。我们报告的总体并发症发生率为每位患者10.
