Patel Rajal A, Bell Jonathan B, Kim Thomas, Agulnik Mark, Chandler James P, Mittal Bharat B, Kruser Tim J
Department of Radiation Oncology, Northwestern Memorial Hospital, 251 E. Huron St., Galter Pavilion LC-178, Chicago, IL, 60611, USA.
Division of Hematology/Oncology, Department of Medicine, Northwestern Memorial Hospital, 676 North Saint Clair St., Suite 850, Chicago, IL, 60611, USA.
J Neurooncol. 2017 Aug;134(1):197-203. doi: 10.1007/s11060-017-2509-6. Epub 2017 May 25.
Patients with head and neck malignancies commonly develop metastatic disease, yet rarely do these carcinomas metastasize to the brain. Stereotactic radiosurgery (SRS) is routinely employed to treat brain metastases (BM). This study was undertaken to examine the efficacy of SRS for BM from primary head and neck carcinomas. From 2000 to 2016, a total of 19 patients with 38 lesions were retrospectively identified. All patients presented with a primary head and neck malignancy and subsequently developed metastatic disease to the brain treated with SRS at our institution. Actuarial rates for overall survival (OS), local control (LC) and distant brain metastases (DBM) were calculated using Kaplan-Meier estimates. Median follow up was 6.8 months and median survival was 15.8 months. Eleven lesions received post-operative SRS to a surgical cavity and 27 lesions received definitive SRS to a metastasis. The median dose prescribed was 18 Gy. One-year actuarial rate for LC was 77.3% (95% confidence interval [CI] 44-92%) while 1 year and 2 year rates of OS were 52.9% (CI 28-73%) and 31.7% (CI 11-55%) respectively. The median time to develop DBM was 8.4 months. Three patients (16%) underwent repeat SRS following development of new BM and three patients (16%) underwent salvage whole brain radiotherapy (WBRT). SRS may be utilized in the treatment of patients with primary head and neck malignancies metastasized to the brain with high efficacy. Patients with well-controlled systemic disease and good performance status may benefit the most from definitive SRS while avoiding WBRT.
头颈部恶性肿瘤患者通常会发生转移性疾病，但这些癌症很少转移至脑。立体定向放射外科（SRS）常规用于治疗脑转移瘤（BM）。本研究旨在探讨SRS治疗原发性头颈部癌脑转移瘤的疗效。2000年至2016年，共回顾性确定了19例患者的38个病灶。所有患者均患有原发性头颈部恶性肿瘤，随后在我院接受SRS治疗脑转移性疾病。采用Kaplan-Meier估计法计算总生存（OS）、局部控制（LC）和远处脑转移（DBM）的精算率。中位随访时间为6.8个月，中位生存期为15.8个月。11个病灶接受了术后SRS治疗手术腔，27个病灶接受了针对转移灶的根治性SRS治疗。规定的中位剂量为18 Gy。LC的1年精算率为77.3%（95%置信区间[CI] 44-92%），而OS的1年和2年率分别为52.9%（CI 28-73%）和31.7%（CI 11-55%）。发生DBM的中位时间为8.4个月。3例患者（16%）在出现新的BM后接受了重复SRS，3例患者（16%）接受了挽救性全脑放疗（WBRT）。SRS可有效用于治疗原发性头颈部恶性肿瘤脑转移患者。全身疾病控制良好且体能状态良好的患者可能从根治性SRS中获益最大，同时避免WBRT。
