Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N, Saito T
Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
Sonodakai Radiation Oncology Clinic, Adachi-ku, Tokyo, Japan.
Asia Pac J Clin Oncol. 2017 Oct;13(5):e449-e457. doi: 10.1111/ajco.12597. Epub 2016 Sep 13.
Important factors typically associated with prognosis in brain metastases include Karnofsky performance status (KPS), extracranial or cerebellar localization and combination chemotherapy. However, few studies investigated the prognostic role of leptomeningeal metastases (LM) following whole brain radiotherapy (WBRT). On the basis of our experience suggesting better survival of asymptomatic patients with LM than those with brain metastases, we herein evaluated LM as a prognostic factor after WBRT.
Medical records of 206 patients (median age, 65 years) who received WBRT in 2007-2015 were retrospectively reviewed. The two most common cancers were of lung, breast origin in 78.5%, 10%, patients, respectively. Patients received parallel-opposed WBRT, with a dose of 20-40 Gy. Additional doses of 9-12 Gy were used in patients who were operated on or had single metastases. Overall survival (OS) was determined, and clinical parameters including age, KPS, symptoms, radiation dose, dose per fraction, type of metastasis, extracranial metastases, primary status and surgery plus WBRT were assessed as prognostic factors.
The median survival was 6 months (range, 1-100), and 1- and 2-year survival rates were 28% and 17%, respectively. In univariate analysis, improved survival was associated with KPS of ≥70, absence of symptoms, radiation dose of ≥37.5 Gy, favorable primary lesion, LM, and surgery plus WBRT. Multivariate analysis revealed that these factors with the exception of radiation dose was significant prognostic factors for OS.
We found that LM were independent prognostic factors for good clinical outcomes.
通常与脑转移预后相关的重要因素包括卡氏功能状态评分（KPS）、颅外或小脑定位以及联合化疗。然而，很少有研究调查全脑放疗（WBRT）后软脑膜转移（LM）的预后作用。基于我们的经验表明，无症状LM患者比脑转移患者生存期更长，我们在此评估WBRT后LM作为一个预后因素。
回顾性分析2007年至2015年接受WBRT的206例患者（中位年龄65岁）的病历。两种最常见的癌症分别为肺癌和乳腺癌，分别占78.5%和10%。患者接受对穿野WBRT，剂量为20 - 40 Gy。对接受手术或单发转移的患者追加9 - 12 Gy剂量。确定总生存期（OS），并评估包括年龄、KPS、症状、放射剂量、分次剂量、转移类型、颅外转移、原发状态以及手术加WBRT等临床参数作为预后因素。
中位生存期为6个月（范围1 - 100个月），1年和2年生存率分别为28%和17%。单因素分析显示，生存期改善与KPS≥70、无症状、放射剂量≥37. Gy、原发灶情况良好、LM以及手术加WBRT有关。多因素分析显示，除放射剂量外，这些因素是OS的显著预后因素。
我们发现LM是良好临床结局的独立预后因素。
