Sheppard John P, Prashant Giyarpuram N, Chen Cheng Hao Jacky, Peeters Sophie, Lagman Carlito, Ong Vera, Udawatta Methma, Duong Courtney, Nguyen Thien, Romiyo Prasanth, Gaonkar Bilwaj, Yong William H, Kaprealian Tania B, Tenn Stephen, Lee Percy, Yang Isaac
Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, United States.
Department of Pathology, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, United States.
Clin Neurol Neurosurg. 2019 Aug;183:105389. doi: 10.1016/j.clineuro.2019.105389. Epub 2019 Jun 15.
To investigate if delay of adjuvant radiotherapy (ART) beyond 6 post-operative weeks affects survival outcomes in patients undergoing craniotomy or craniectomy for resection of non-small cell lung cancer (NSCLC) intracranial metastases.
We performed a retrospective analysis of 28 patients undergoing resection of intracranial metastases and ART at our institution from 2001 to 2016. We assessed survival outcomes for patients who received delayed versus non-delayed ART, as well as associated risk factors.
Among 28 patients, 8 (29%) had delayed ART beyond 6 post-operative weeks. Fifteen received stereotactic radiotherapy (SRT), 8 (29%) received whole brain radiotherapy (WBRT), and 5 (18%) received combination WBRT + SRT. There were no significant differences in ART modality or dosing, age, sex, number of intracranial metastases, primary metastasis volume, rates of chemotherapy, extracranial metastases, or post-operative functional scores between groups. Expected post-operative survival was shorter with delayed ART (7 months versus 28 months, P = 0.01). The most common reason for delayed ART was complicated post-operative course (n = 3.38%). Significant risk factors for delayed ART included non-routine discharge (P = 0.01) and additional invasive procedures between surgery and ART start date (P = 0.02).
Our results suggest delayed ART in patients undergoing surgical resection of intracranial NSCLC metastases is associated with shorter overall survival. However, risk factors for delayed ART, including non-routine discharge and the need for additional invasive procedures, may have in themselves reflected poorer clinical courses that may have also contributed to the observed survival differences.
探讨辅助放疗（ART）延迟至术后6周以上是否会影响接受开颅手术或颅骨切除术切除非小细胞肺癌（NSCLC）颅内转移灶患者的生存结局。
我们对2001年至2016年在我院接受颅内转移灶切除及ART的28例患者进行了回顾性分析。我们评估了接受延迟ART与未延迟ART患者的生存结局以及相关危险因素。
28例患者中，8例（29%）ART延迟至术后6周以上。15例接受立体定向放疗（SRT），8例（29%）接受全脑放疗（WBRT），5例（18%）接受WBRT+SRT联合治疗。两组之间在ART方式或剂量、年龄、性别、颅内转移灶数量、原发转移灶体积、化疗率、颅外转移灶或术后功能评分方面无显著差异。延迟ART患者的预期术后生存期较短（7个月对28个月，P=0.01）。ART延迟的最常见原因是术后病程复杂（n=3,38%）。ART延迟的显著危险因素包括非常规出院（P=0.01）以及手术与ART开始日期之间进行额外的侵入性操作（P=0.02）。
我们的结果表明，接受颅内NSCLC转移灶手术切除的患者延迟ART与较短的总生存期相关。然而，ART延迟的危险因素，包括非常规出院和需要进行额外的侵入性操作，本身可能反映了较差的临床病程，这也可能导致了观察到的生存差异。
