Columbia University College of Physicians and Surgeons, New York, NY, USA.
Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.
J Neurooncol. 2018 Jan;136(2):281-287. doi: 10.1007/s11060-017-2651-1. Epub 2017 Nov 23.
Prior studies of post-operative stereotactic radiosurgery (SRS) have not distinguished between Adjuvant SRS (ARS) versus Adjuvant SRS to residual/recurrent disease (ARD). In this study, we defined ARS and ARD and investigated local control (LC), overall survival (OS), distant development of brain metastases (DBF), and leptomeningeal disease (LMD). We retrospectively identified BM patients who received surgical resection and SRS for BM from an IRB approved database between Jan 2009-Aug 2015. Patients were stratified into two groups: ARS and ARD. LC was determined by follow-up MRI studies and OS was measured from the date of surgery. LC and OS were assessed using the Kaplan-Meier method. 70 cavities underwent surgical resection of BM and received SRS to the post-operative bed. 41 cavities were classified as ARS and 29 as ARD. There was no significant difference in 12-month LC between the ARS and ARD group (71.4 vs. 80.8%, respectively; p = 0.135) from the time point of SRS. The overall 1-year survival for ARS and ARD was 79.9 and 86.1%, respectively (p = 0.339). Mean time to progression was 6.45 and 8.0 months and median follow-up was 10 and 15 months for ARS and ARD, respectively. 11.8% of ARS patients and 15.4% of ARD patients developed LMD, p = 0.72. 29.4% of ARS and 48.0% of ARD patients developed DBF, p = 0.145. Our findings suggest that observation after surgical resection, with subsequent treatment with SRS after the development of local failure, may not compromise treatment efficacy. If validated, this would spare patients who do not recur post-surgically from additional treatment.
先前关于术后立体定向放射外科（SRS）的研究并未区分辅助性 SRS（ARS）和残留/复发性疾病的辅助性 SRS（ARD）。在这项研究中，我们定义了 ARS 和 ARD，并研究了局部控制（LC）、总生存（OS）、远处脑转移瘤（DBF）和软脑膜疾病（LMD）的发展情况。我们回顾性地从 2009 年 1 月至 2015 年 8 月期间，从经机构审查委员会批准的数据库中确定了接受手术切除和 SRS 治疗脑转移瘤的患者。患者分为两组：ARS 和 ARD。LC 通过随访 MRI 研究确定，OS 从手术日期开始计算。LC 和 OS 使用 Kaplan-Meier 方法进行评估。70 个空洞接受了脑转移瘤的手术切除，并接受了术后床的 SRS。41 个空洞被归类为 ARS，29 个为 ARD。ARS 和 ARD 两组之间在 SRS 后 12 个月 LC 无显著差异（分别为 71.4%和 80.8%；p=0.135）。ARS 和 ARD 的总体 1 年生存率分别为 79.9%和 86.1%（p=0.339）。进展时间的平均值分别为 6.45 和 8.0 个月，ARS 和 ARD 的中位随访时间分别为 10 和 15 个月。ARS 患者中有 11.8%和 ARD 患者中有 15.4%发生 LMD，p=0.72。ARS 患者中有 29.4%和 ARD 患者中有 48.0%发生 DBF，p=0.145。我们的研究结果表明，在手术后观察，然后在局部失败后再进行 SRS 治疗，可能不会影响治疗效果。如果得到验证，这将使术后未复发的患者免受额外治疗的影响。
