Gamma Knife Center Tilburg, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Pulmonary Diseases, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.
Clin Oncol (R Coll Radiol). 2020 Jan;32(1):52-59. doi: 10.1016/j.clon.2019.07.004. Epub 2019 Jul 22.
Little understanding exists of referral patterns for patients with brain metastasis from non-small cell lung cancer (NSCLC) towards treatment with Gamma Knife radiosurgery (GKRS). Therefore, we explored current clinical daily practice and prognosis.
In total, 1129 patients with synchronously diagnosed brain metastasis from NSCLC diagnosed between 2008 and 2014 were selected from the population-based Netherlands Cancer Registry; 242 patients were treated with GKRS.
Patients receiving GKRS were younger (62 years versus 64 years) and had lower tumour burden: the presence of T2 was higher and T4 was lower (43% versus 33%; P = 0.0158, 19% versus 28%; P = 0.0044, respectively). They more frequently had cN0 (32% versus 19%; P ≤ 0.0001), less frequently had N3 disease (18% versus 29%; P = 0.0004) and there were fewer metastatic sites. In multivariable logistic regression analysis, only age ≤60 years (odds ratio 1.4; 95% confidence interval 1.0-2.0) and patients with N0 stage, compared with those with N2, N3 and NX (odds ratio 0.6 [0.4-0.9], 0.3 [0.2-0.6], 0.3 [0.1-0.6], respectively), were more likely to receive GKRS. Gender, T-stage, histology, number of comorbidities, country of birth as proxy for ethnicity and socioeconomic status were not associated. The median survival was 9.6 months after GKRS versus 4.0 months in the noGKRS group (Log-rank: P ≤ 0.0001). Multivariably, GKRS, female, lower T-/N-stage, <2 comorbidities, adenocarcinoma and higher socioeconomic status were associated with a significantly reduced hazard of death. For the patients with at least one follow-up magnetic resonance image (80%), local intracranial tumour control was achieved in 93% at the last follow-up.
Patients presenting with synchronic brain metastasis from NSCLC who are referred to a third-line treatment centre for GKRS are younger and have a lower tumour load. Due to a high level of local control, GKRS is able to provide a significant window of opportunity for additional treatment of the primary tumour.
对于同步诊断为非小细胞肺癌脑转移的患者，目前对于其接受伽玛刀放射外科（GKRS）治疗的转诊模式了解甚少。因此，我们探索了当前的临床实践和预后情况。
从基于人群的荷兰癌症登记处中选择了 1129 名同步诊断为非小细胞肺癌脑转移的患者，这些患者于 2008 年至 2014 年期间被确诊，其中 242 名患者接受了 GKRS 治疗。
接受 GKRS 治疗的患者年龄较小（62 岁与 64 岁），肿瘤负担较低：T2 期患者比例较高（43%与 33%；P=0.0158），T4 期患者比例较低（19%与 28%；P=0.0044）。他们更常出现 cN0（32%与 19%；P≤0.0001），较少出现 N3 期疾病（18%与 29%；P=0.0004），转移灶数量也较少。在多变量逻辑回归分析中，仅年龄≤60 岁（优势比 1.4；95%置信区间 1.0-2.0）和 N0 期患者（与 N2、N3 和 NX 相比，优势比 0.6 [0.4-0.9]、0.3 [0.2-0.6]、0.3 [0.1-0.6]）更有可能接受 GKRS 治疗。性别、T 分期、组织学、合并症数量、出生国家（代表种族）和社会经济地位与 GKRS 治疗无相关性。GKRS 组的中位生存期为 9.6 个月，而未接受 GKRS 治疗的患者为 4.0 个月（对数秩检验：P≤0.0001）。多变量分析表明，GKRS、女性、较低的 T/N 分期、合并症数量<2、腺癌和较高的社会经济地位与死亡风险显著降低相关。对于至少有一次随访磁共振成像（80%）的患者，最后一次随访时，93%的患者局部颅内肿瘤得到控制。
接受 GKRS 三线治疗的同步诊断为非小细胞肺癌脑转移患者年龄较小，肿瘤负荷较低。由于局部控制率较高，GKRS 能够为原发性肿瘤的进一步治疗提供显著的机会窗口。
