Brown D R, Lanciano R, Heal C, Hanlon A, Yang J, Feng J, Stanley M, Buonocore R, Okpaku A, Ding W, Arrigo S, Lamond J, Brady L
Philadelphia CyberKnife, Crozer-Keystone Health System, 2010 W Chester Pike #1050, Havertown, 19083 PA USA.
Drexel University College of Medicine, Philadelphia, PA USA.
J Radiat Oncol. 2017;6(1):31-37. doi: 10.1007/s13566-016-0287-y. Epub 2016 Dec 6.
The objective of the present study is to analyze prognostic factors affecting survival of patients receiving stereotactic radiosurgery (SRS) for second brain metastatic event (SBME) following initial treatment with whole brain irradiation (WBI), surgical resection, or previous SRS.
The 88 patients treated with SRS for SBME at Philadelphia CyberKnife between January 2006 and October 2013 were included in the study group. Cox proportional-hazards regression was used to identify prognostic factors that significantly impacted survival from the time of SRS for SBME. Independent variables considered in survival analysis included primary disease, first brain metastatic event (FBME) treatment type, age, gender, number of brain metastases at SBME, Karnofsky performance status (KPS), recursive partitioning analysis (RPA), and presence of extracranial metastasis.
The median survival for all patients was 7.31 months. Log-rank comparison of Kaplan-Meier survival curves revealed significant impact by Karnofsky performance status ( = 0.003), RPA class ( = 0.008), age ( = 0.014), and FBME treatment type ( = 0.010). Median survival was longer for patients who had not previously received WBI (14.7 months). Median survival was further increased in patients who had not received previous WBI and demonstrated KPS scores of 70-100 (19.5 months). Patients who received WBI prior to SBME treatment experienced a pronounced decrement in median survival (5.7 months), yet patients in this group who demonstrated strong KPS scores (80-100) experienced significantly increased survival (15.5 months).
The outcomes of SRS for SBME are most favorable for patients who have not received previous WBI or who have maintained higher performance status despite previous WBI.
本研究的目的是分析影响接受立体定向放射外科治疗（SRS）的患者在初次接受全脑照射（WBI）、手术切除或先前SRS治疗后发生第二次脑转移事件（SBME）后的生存预后因素。
2006年1月至2013年10月在费城射波刀中心接受SRS治疗SBME的88例患者纳入研究组。采用Cox比例风险回归分析确定从SRS治疗SBME时起对生存有显著影响的预后因素。生存分析中考虑的自变量包括原发疾病、首次脑转移事件（FBME）的治疗类型、年龄、性别、SBME时脑转移灶数量、卡诺夫斯基功能状态评分（KPS）、递归划分分析（RPA）和颅外转移情况。
所有患者的中位生存期为7.31个月。Kaplan-Meier生存曲线的对数秩比较显示，卡诺夫斯基功能状态评分（P = 0.003）、RPA分级（P = 0.008）、年龄（P = 0.014）和FBME治疗类型（P = 0.010）对生存有显著影响。未接受过WBI的患者中位生存期较长（14.7个月）。未接受过WBI且KPS评分为70 - 100的患者中位生存期进一步延长（19.5个月）。在SBME治疗前接受过WBI的患者中位生存期显著缩短（5.7个月），但该组中KPS评分较高（80 - 100）的患者生存期显著延长（15.5个月）。
对于未接受过先前WBI或尽管接受过先前WBI但仍保持较高功能状态的患者，SRS治疗SBME的效果最为理想。
