Zhang Ying, Chang Eric L
Department of Radiation Oncology, Keck School of Medicine of USC, Norris Cancer Hospital and LAC+USC Medical Center, Los Angeles, CA, USA.
J Radiosurg SBRT. 2014;3(2):91-102.
This study aims to perform a systematic review of published literature addressing outcomes related to postoperative stereotactic radiosurgery (SRS) delivered to the cavity of resected intracranial metastases.
A thorough literature search was performed on all reports published in English of SRS to the resection cavity after surgical resection, in patients who did not receive immediate whole brain radiotherapy (WBRT).
15 single-institution publications were identified which fit the search criteria. In 11 of the 13 studies that reported on number of lesions treated (85%), more than 50% of the patients had a single lesion. 11 publications (73%) reported the percentage of gross total resections (GTR) , which ranged from 68-100%. The predominant histology was non-small cell lung cancer. Modalities used included GammaKnife, CyberKnife, and linac-based radiosurgical platforms. Nine institutions (60%) added a margin to the post-surgical cavity. One year local control ranged between 74-91.5%. Distant brain recurrences occurred at a median of 53.8% of the time at a median of 7.8 months. Very few (<10%) patients developed symptomatic necrosis. Leptomeningeal disease incidence at recurrence was reported in four studies ranging from 4.2% to 25%, with 44.4% to 50% occurring in the posterior fossa. Salvage therapy included WBRT used 19-47% of the time at a median of 8months.
Postsurgical SRS is a safe and effective modality that can be used to limit recurrences in the postoperative cavity when postoperative WBRT is omitted but does not address distant intracranial recurrences. Further investigation of its efficacy and toxicity is ongoing in a randomized control trial.
本研究旨在对已发表的关于术后立体定向放射外科治疗（SRS）用于颅内转移瘤切除腔的相关文献进行系统综述。
对未接受即刻全脑放疗（WBRT）的患者，在手术切除后对切除腔进行SRS治疗的所有英文报道进行全面的文献检索。
共确定了15篇符合检索标准的单机构出版物。在13项报告治疗病灶数量的研究中，有11项（85%）显示超过50%的患者有单个病灶。11篇出版物（73%）报告了大体肿瘤全切除（GTR）的百分比，范围为68%-100%。主要组织学类型为非小细胞肺癌。使用的治疗方式包括伽玛刀、射波刀和基于直线加速器的放射外科平台。9家机构（60%）在术后腔周围增加了边缘。一年局部控制率在74%-91.5%之间。远处脑复发的中位时间为7.8个月，发生率中位数为53.8%。很少（<10%）患者出现症状性坏死。四项研究报告了复发时软脑膜疾病的发生率，范围为4.2%-25%，后颅窝发生率为44.4%-50%。挽救性治疗包括WBRT，使用时间中位数为8个月，占19%-47%。
术后SRS是一种安全有效的治疗方式，当省略术后WBRT时，可用于限制术后腔内复发，但不能解决颅内远处复发问题。一项随机对照试验正在对其疗效和毒性进行进一步研究。
