Kim Il Kyoon, Starke Robert M, McRae Donald A, Nasr Nadim M, Caputy Anthony, Cernica George D, Hong Robert L, Sherman Jonathan H
School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
J Clin Neurosci. 2017 May;39:142-146. doi: 10.1016/j.jocn.2016.12.006. Epub 2017 Jan 11.
Recent studies have demonstrated diminished cognitive function, worse quality of life, and no overall survival benefit from the addition of adjuvant whole brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) in the management of brain metastases. This study analyzes the treatment outcome of SRS, specifically CyberKnife Radiosurgery, based on the total tumor volume compared to the absolute number of lesions.
A retrospective analysis of hospital records at Virginia Hospital Center for patients with brain metastases who underwent CyberKnife Radiosurgery between June 2008 and June 2014 was performed. Previous treatment history, metastatic tumor dimensions, and outcomes were recorded. Predictors of neurological defects, local tumor progression, and overall survival were assessed with univariate and multivariate analysis.
We identified 130 adult patients with a median age of 61.5years and a median follow-up of 7.1months. Unfavorable outcomes such as death, tumor progression, or neurological defect showed correlation with cumulative tumor volume greater than the median volume of 7cc (p<0.05). Worsening neurological defects showed an association with an increased number of lesions (p<0.02) and age (p<0.05). For local tumor progression, patients who have received WBRT were less likely to progress (.74, 95% CI, .48, 1.10), while those who received chemotherapy (1.48 95% CI, .98, 2.26), or surgery (1.56 95%, CI .98, 2.47) without WBRT were more likely to progress.
Our data suggest that a cumulative tumor volume greater than 7cc correlates with worse outcomes following CyberKnife Radiosurgery. In addition, WBRT appears to have a role in improved survival for patients with increased tumor burden. A prospective study is warranted to validate these findings.
近期研究表明，在脑转移瘤的治疗中，辅助性全脑放射治疗（WBRT）联合立体定向放射外科治疗（SRS）并未改善认知功能、生活质量，也未带来总体生存获益。本研究基于肿瘤总体积与病灶绝对数量，分析了SRS（特别是射波刀放射外科治疗）的治疗效果。
对2008年6月至2014年6月间在弗吉尼亚医院中心接受射波刀放射外科治疗的脑转移瘤患者的医院记录进行回顾性分析。记录既往治疗史、转移性肿瘤大小及治疗结果。通过单因素和多因素分析评估神经功能缺损、局部肿瘤进展及总体生存的预测因素。
我们纳入了130例成年患者，中位年龄61.5岁，中位随访时间7.1个月。死亡、肿瘤进展或神经功能缺损等不良结局与累积肿瘤体积大于中位数7cc相关（p<0.05）。神经功能缺损恶化与病灶数量增加（p<0.02）及年龄增长（p<0.05）相关。对于局部肿瘤进展，接受过WBRT的患者进展可能性较小（.74，95%CI，.48，1.10），而未接受WBRT但接受过化疗（1.48，95%CI，.98，2.26）或手术（1.56，95%CI，.98，2.47）的患者进展可能性更大。
我们的数据表明，累积肿瘤体积大于7cc与射波刀放射外科治疗后较差的结局相关。此外，WBRT似乎对肿瘤负荷增加的患者生存改善有作用。有必要进行前瞻性研究以验证这些发现。
