Wang Tony J C, Saad Shumaila, Qureshi Yasir H, Jani Ashish, Isaacson Steven R, Sisti Michael B, Bruce Jeffrey N, McKhann Guy M, Lesser Jeraldine, Cheng Simon K, Clifford Chao K S, Lassman Andrew B
Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA,
J Neurooncol. 2015 Apr;122(2):399-408. doi: 10.1007/s11060-015-1728-y. Epub 2015 Feb 17.
Optimal treatment of brain metastases (BMs) is debatable. However, surgery or gamma knife radiosurgery (GKRS) improves survival when combined with whole brain radiotherapy (WBRT) versus WBRT alone. We retrospectively reviewed an institutional database of patients treated with GKRS for BMs from 1998 to 2013 to explore effects of single or multi-modality therapies on survival. There were 528 patients with median age 62 years. Histologies included 257 lung, 102 breast, 62 melanoma, 40 renal cell, 29 gastrointestinal, and 38 other primary cancers. Treatments included: 206 GKRS alone, 111 GKRS plus WBRT, 109 GKRS plus neurosurgical resection (NSG), and 102 all three modalities. Median overall survival (mOS) was 16.6 months. mOS among patients with one versus multiple metastasis was 17.2 versus 16.0 months respectively (p = 0.825). For patients with one BM, mOS following GKRS alone, GKRS plus WBRT, GKRS plus NSG, and all three modalities was 9.0, 19.1, 25.5, and 25.0 months, respectively, and for patients with multiple BMs, mOS was 8.6, 20.4, 20.7, 24.5 months for the respective groups. Among all patients, multivariate analysis confirmed that tri-modality group had the longest survival (HR 0.467; 95 % CI 0.350-0.623; p < 0.001) compared to GKRS alone; however, this was not significantly different than bi-modality approaches. Uncontrolled primary extra-CNS disease, age and KPS were also independent predictors of survival. Patients treated with GKRS plus NSG, GKRS plus WBRT, or all three modalities had improved OS versus GKRS alone. In our analysis, resection and GKRS allowed avoidance of WBRT without shortening survival.
脑转移瘤（BMs）的最佳治疗方法存在争议。然而，与单纯全脑放疗（WBRT）相比，手术或伽玛刀放射外科手术（GKRS）联合WBRT可提高生存率。我们回顾性分析了1998年至2013年期间接受GKRS治疗BMs的患者的机构数据库，以探讨单模态或多模态治疗对生存率的影响。共有528例患者，中位年龄为62岁。组织学类型包括257例肺癌、102例乳腺癌、62例黑色素瘤、40例肾细胞癌、29例胃肠道癌和38例其他原发性癌症。治疗方法包括：206例单纯GKRS、111例GKRS联合WBRT、109例GKRS联合神经外科切除术（NSG）以及102例三种方法联合使用。中位总生存期（mOS）为16.6个月。单发转移与多发转移患者的mOS分别为17.2个月和16.0个月（p = 0.825）。对于单发BM患者，单纯GKRS、GKRS联合WBRT、GKRS联合NSG以及三种方法联合使用后的mOS分别为9.0个月、19.1个月、25.5个月和25.0个月；对于多发BM患者，各治疗组的mOS分别为8.6个月、20.4个月、20.7个月和24.5个月。在所有患者中，多因素分析证实，与单纯GKRS相比，三联治疗组的生存期最长（风险比0.467；95%可信区间0.350 - 0.623；p < 0.001）；然而，这与双模态治疗方法并无显著差异。无法控制的原发性中枢神经系统外疾病、年龄和KPS也是生存的独立预测因素。与单纯GKRS相比，接受GKRS联合NSG、GKRS联合WBRT或三种方法联合使用的患者的总生存期有所改善。在我们的分析中，切除手术和GKRS可避免WBRT且不缩短生存期。
