Yomo Shoji, Hayashi Motohiro
Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, 2-5-1, Honjo, Matsumoto, Nagano, 390-0814, Japan.
Saitama Gamma Knife Center, San-ai Hospital, Saitama, Japan.
BMC Cancer. 2015 Mar 4;15:95. doi: 10.1186/s12885-015-1103-6.
Because of the high likelihood of multiple brain metastases (BM) from small cell lung cancer (SCLC), the role of focal treatment using stereotactic radiosurgery (SRS) has yet to be determined. We aimed to evaluate the efficacy and limitations of upfront and salvage SRS for patients with BM from SCLC.
This was a retrospective and observational study analyzing 70 consecutive patients with BM from SCLC who received SRS. The median age was 68 years, and the median Karnofsky performance status (KPS) was 90. Forty-six (66%) and 24 (34%) patients underwent SRS as the upfront and salvage treatment after prophylactic or therapeutic whole brain radiotherapy (WBRT), respectively. Overall survival (OS), neurological death-free survival, remote and local tumor recurrence rates were analyzed.
None of our patients were lost to follow-up and the median follow-up was 7.8 months. One-and 2-year OS rates were 43% and 15%, respectively. The median OS time was 7.8 months. One-and 2-year neurological death-free survival rates were 94% and 84%, respectively. In total, 219/292 tumors (75%) in 60 patients (86 %) with sufficient radiological follow-up data were evaluated. Six-and 12-month rates of remote BM relapse were 25% and 47%, respectively. Six-and 12-month rates of local control failure were 4% and 23%, respectively. Repeat SRS, salvage WBRT and microsurgery were subsequently required in 30, 8 and one patient, respectively. Symptomatic radiation injury, treated conservatively, developed in 3 patients.
The present study suggested SRS to be a potentially effective and minimally invasive treatment option for BM from SCLC either alone or after failed WBRT. Although repeat salvage treatment was needed in nearly half of patients to achieve control of distant BM, such continuation of radiotherapeutic management might contribute to reducing the rate of neurological death.
由于小细胞肺癌（SCLC）发生多发性脑转移（BM）的可能性很高，立体定向放射外科（SRS）局部治疗的作用尚未确定。我们旨在评估SRS对SCLC脑转移患者进行初始治疗和挽救治疗的疗效及局限性。
这是一项回顾性观察性研究分析了70例连续接受SRS治疗的SCLC脑转移患者。中位年龄为68岁，中位卡诺夫斯基功能状态（KPS）为90。46例（66%）和24例（34%）患者分别在预防性或治疗性全脑放疗（WBRT）后接受SRS作为初始治疗和挽救治疗。分析总生存期（OS）、无神经功能死亡生存期、远处和局部肿瘤复发率。
我们的患者均无失访，中位随访时间为7.8个月。1年和2年总生存率分别为43%和15%。中位总生存时间为7.8个月。1年和2年无神经功能死亡生存率分别为94%和84%。共有60例患者（86%）有足够的影像学随访数据，共292个肿瘤，其中219个（75%）被评估。远处脑转移复发的6个月和12个月发生率分别为25%和47%。局部控制失败的6个月和12个月发生率分别为4%和23%。随后分别有30例、8例和1例患者需要重复SRS、挽救性WBRT和显微手术。3例患者出现了经保守治疗的放射性损伤症状。
本研究表明，SRS对于SCLC脑转移无论是单独使用还是在WBRT失败后，都是一种潜在有效的微创治疗选择。虽然近一半的患者需要重复挽救治疗以控制远处脑转移，但这种持续的放射治疗管理可能有助于降低神经功能死亡的发生率。
