Cohen-Inbar Or, Melmer Patrick, Lee Cheng-chia, Xu Zhiyuan, Schlesinger David, Sheehan Jason P
J Neurooncol. 2016 Jan;126(2):289-98. doi: 10.1007/s11060-015-1962-3.
Brain metastases (BM) develop in 10-30 % of patients. Stereotactic radiosurgery (SRS) was shown to improve local control, and performance status, in certain cohorts of brain metastasis patients. The cumulative neurocognitive effect of numerous SRS sessions remains unknown. Leukoencephalopathy is significant diffuse white matter changes and it usually implies a neurocognitive decline. We report patients with BM who survived >2 years after SRS. Clinical and treatment parameters were analyzed for development of leukoencephalopathy. Multiple parameters as well as leukoencephalopathy grade changes were recorded. The median clinical and radiological follow-up was 42 and 41 months (range 24–115 and 24–115) respectively. The cohort included 92 patients and 704 lesions. The most common malignancies were non-small cell lung carcinoma (44.5 % n = 41), breast adenocarcinoma (23.9 %, n = 22) and melanoma (16.3 %,n = 15). 27.6 % (n = 26) of patients underwent adjuvant WBRT. At last follow up, local tumor control was achieved in 76.3 % (n = 61) of patients and 71.8 % (n = 461) of lesions. Overall prevalence of leukoencephalopathy was 42, 60, 73 and 84 % at 1, 2, 3, and 4 years after SRS. Moderate-severe leukoencephalopathy development was related to an integral dose to skull >3 Joules (p = 0.012) at any radiosurgical treatment and prior WBRT (p<0.042). Leukoencephalopathy incidence was consistently higher in the WBRT + SRS group at each following year of survival from initial SRS. Long-term BM survivors treated with SRS are at progressive risk for developing leukoencephalopathy.Those with a higher BM burden, higher integral SRS dose to the skull, and treatment with WBRT are at increased risk of leukoencephalopathy.
10% - 30%的患者会发生脑转移（BM）。立体定向放射外科手术（SRS）已被证明可改善某些脑转移患者群体的局部控制和功能状态。多次SRS治疗的累积神经认知效应尚不清楚。白质脑病是显著的弥漫性白质改变，通常意味着神经认知功能下降。我们报告了SRS后存活超过2年的BM患者。分析临床和治疗参数以了解白质脑病的发生情况。记录了多个参数以及白质脑病分级变化。临床和影像学的中位随访时间分别为42个月和41个月（范围24 - 115个月和24 - 115个月）。该队列包括92例患者和704个病灶。最常见的恶性肿瘤是非小细胞肺癌（44.5%，n = 41）、乳腺腺癌（23.9%，n = 22）和黑色素瘤（16.3%，n = 15）。27.6%（n = 26）的患者接受了辅助全脑放疗（WBRT）。在最后一次随访时，76.3%（n = 61）的患者和71.8%（n = 461）的病灶实现了局部肿瘤控制。SRS后1、2、3和4年白质脑病的总体患病率分别为42%、60%、73%和84%。中度至重度白质脑病的发生与任何放射外科治疗时颅骨的积分剂量>3焦耳（p = 0.012）以及既往WBRT（p<0.042）有关。从首次SRS开始，在随后的每一年生存中，WBRT + SRS组的白质脑病发病率始终较高。接受SRS治疗的长期BM幸存者有发生白质脑病的渐进性风险。那些BM负担较高、SRS对颅骨的积分剂量较高以及接受WBRT治疗的患者发生白质脑病的风险增加。
