立体定向放射外科治疗的脑转移瘤患者手术切除与软脑膜复发风险。

Surgical Resection of Brain Metastases and the Risk of Leptomeningeal Recurrence in Patients Treated With Stereotactic Radiosurgery.

机构信息

Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan.

出版信息

Int J Radiat Oncol Biol Phys. 2016 Mar 1;94(3):537-43. doi: 10.1016/j.ijrobp.2015.11.022. Epub 2015 Nov 19.

DOI:10.1016/j.ijrobp.2015.11.022

PMID:26867883

Abstract

PURPOSE

Recent prospective data have shown that patients with solitary or oligometastatic disease to the brain may be treated with upfront stereotactic radiosurgery (SRS) with deferral of whole-brain radiation therapy (WBRT). This has been extrapolated to the treatment of patients with resected lesions. The aim of this study was to assess the risk of leptomeningeal disease (LMD) in patients treated with SRS to the postsurgical resection cavity for brain metastases compared with patients treated with SRS to intact metastases.

METHODS AND MATERIALS

Four hundred sixty-five patients treated with SRS without upfront WBRT at a single institution were identified; 330 of these with at least 3 months' follow-up were included in this analysis. One hundred twelve patients had undergone surgical resection of at least 1 lesion before SRS compared with 218 treated for intact metastases. Time to LMD and overall survival (OS) time were estimated from date of radiosurgery, and LMD was analyzed by the use of cumulative incidence method with death as a competing risk. Univariate and multivariate analyses were performed with competing risk regression to determine whether various clinical factors predicted for LMD.

RESULTS

With a median follow-up time of 9.0 months, 39 patients (12%) experienced LMD at a median of 6.0 months after SRS. At 1 year, the cumulative incidence of LMD, with death as a competing risk, was 5.2% for the patients without surgical resection versus 16.9% for those treated with surgery (Gray test, P<.01). On multivariate analysis, prior surgical resection (P<.01) and breast cancer primary (P=.03) were significant predictors of LMD development. The median OS times for patients undergoing surgery compared with SRS alone were 12.9 and 10.6 months, respectively (log-rank P=.06).

CONCLUSIONS

In patients undergoing SRS with deferral of upfront WBRT for intracranial metastatic disease, prior surgical resection and breast cancer primary are associated with an increased risk for the development of LMD.

摘要

目的

最近的前瞻性数据表明，对于仅有孤立性或寡转移性脑转移病灶的患者，可以采用立体定向放射外科（SRS）进行治疗，而延迟全脑放疗（WBRT）。这一方法已经被推广应用于治疗接受过手术切除的患者。本研究的目的是评估与治疗完整脑转移灶的 SRS 相比，治疗手术后脑转移切除腔的患者发生脑膜疾病（LMD）的风险。

方法和材料

在一个机构中确定了 465 名未接受全脑放疗的 SRS 治疗患者；其中 330 名患者的随访时间至少为 3 个月，这些患者被纳入本分析。112 名患者在 SRS 治疗前至少接受过 1 个病灶的手术切除，而 218 名患者则接受了完整转移灶的治疗。LMD 的发病时间和总生存期（OS）时间从放射外科治疗之日开始估计，LMD 采用累积发生率法，以死亡为竞争风险进行分析。采用竞争风险回归进行单因素和多因素分析，以确定各种临床因素是否预测 LMD。

结果

中位随访时间为 9.0 个月，39 名患者（12%）在 SRS 后 6.0 个月时发生 LMD。在 1 年时，以死亡为竞争风险，无手术切除的患者 LMD 的累积发生率为 5.2%，而接受手术治疗的患者为 16.9%（Gray 检验，P<.01）。多因素分析显示，既往手术切除（P<.01）和乳腺癌原发灶（P=.03）是 LMD 发生的显著预测因素。与单独接受 SRS 治疗的患者相比，接受手术的患者的中位 OS 时间分别为 12.9 个月和 10.6 个月（对数秩检验，P=.06）。