Bowden Greg, Kano Hideyuki, Caparosa Ellen, Park Seong-Hyun, Niranjan Ajay, Flickinger John, Lunsford L Dade
Departments of 1 Neurological Surgery and.
J Neurosurg. 2015 Apr;122(4):766-72. doi: 10.3171/2014.12.JNS141111. Epub 2015 Feb 6.
Non-small cell lung cancer (NSCLC) is the most frequent cancer that metastasizes to brain. Stereotactic radiosurgery (SRS) has become the management of choice for most patients with such metastatic tumors. Therefore, the authors endeavored to elucidate the survival and SRS outcomes for patients with NSCLC metastasis at their center.
In this single-institution retrospective analysis, the authors reviewed their experience with NSCLC metastasis during a 10-year period from 2001 to 2010. Seven hundred twenty patients underwent Gamma Knife radiosurgery. A total of 1004 SRS procedures were performed, and 3143 tumors were treated. The NSCLC subtype was adenocarcinoma in 386 patients, squamous cell carcinoma in 111 patients, and large cell carcinoma in 34 patients. The median aggregate tumor volume was 4.5 cm(3) (range 0.1-88 cm(3)).
The median survival time after diagnosis of brain metastasis from NSCLC was 12.6 months, and the median survival after SRS was 8.5 months. The 1-, 2-, and 5-year survival rates after SRS were 39%, 21%, and 10%, respectively. Postradiosurgery survival was decreased in patients treated with prior whole-brain radiation therapy compared with SRS alone (p = 0.003). Aggregate tumor volume was inversely related to survival after SRS (p < 0.001), and the histological subgroups demonstrated significant survival differences (p = 0.023). The overall local tumor control rate in the entire group was 92.8%. One hundred seventy-four patients (24%) underwent repeat SRS for new or resistant metastatic deposits.
Stereotactic radiosurgery is an effective means of providing local control for NSCLC metastases. Neurological function and survival benefit from serial patient monitoring and repeat SRS for new tumors.
非小细胞肺癌（NSCLC）是最常转移至脑部的癌症。立体定向放射外科（SRS）已成为大多数此类转移性肿瘤患者的首选治疗方法。因此，作者致力于阐明其中心NSCLC转移患者的生存情况和SRS治疗结果。
在这项单机构回顾性分析中，作者回顾了他们在2001年至2010年10年间对NSCLC转移的治疗经验。720例患者接受了伽玛刀放射外科治疗。共进行了1004次SRS治疗，治疗了3143个肿瘤。NSCLC亚型中，腺癌386例，鳞状细胞癌111例，大细胞癌34例。肿瘤总体积中位数为4.5 cm³（范围0.1 - 88 cm³）。
NSCLC脑转移诊断后的中位生存时间为12.6个月，SRS治疗后的中位生存时间为8.5个月。SRS治疗后1年、2年和5年生存率分别为39%、21%和10%。与单纯SRS治疗相比，先前接受过全脑放疗的患者放疗后生存率降低（p = 0.003）。肿瘤总体积与SRS治疗后的生存呈负相关（p < 0.001），组织学亚组显示出生存差异有统计学意义（p = 0.023）。整个组的总体局部肿瘤控制率为92.8%。174例患者（24%）因新出现或耐药的转移灶接受了重复SRS治疗。
立体定向放射外科是控制NSCLC转移灶局部生长的有效方法。通过对患者进行连续监测以及对新肿瘤进行重复SRS治疗，可使神经功能和生存获益。
