Department of Neurosurgery, The Second Hospital of Shandong University, Jinan, China.
Institute of Medical Sciences, The Second Hospital of Shandong University, Jinan, China.
Thorac Cancer. 2022 Aug;13(15):2152-2157. doi: 10.1111/1759-7714.14532. Epub 2022 Jun 29.
Current evidence-based guidelines support stereotactic radiosurgery (SRS) for patients with up to four brain metastases (BMs). However, debate continues about how many tumors may be treated by SRS alone.
This retrospective study included non-small cell lung cancer (NSCLC) patients with BMs treated with gamma knife as the initial treatment for cerebral lesions. The patients were followed up to obtain their survival information. The outcomes were statistically analyzed to compare the differences in survival between the <5 BMs and ≥5 BMs groups and to identify prognostic factors.
A total of 77 patients were divided into two groups (54 patients with <5 BMs and 23 patients with ≥5 BMs). The median overall survival (OS) was 18.3 months in the <5 BMs group and 17.7 months in the ≥5 BMs group. The median intracranial progression-free survival (IPFS) was 9.0 months in the <5 BMs group and 9.9 months in the ≥5 BMs group. There was no significant difference in OS and IPFS between the two groups. The multivariate analysis demonstrated that adenocarcinoma, controlled primary cancer, higher Karnofsky Performance Scale (KPS), and salvage treatment were independent prognostic factors favoring longer OS.
SRS alone as the initial treatment for NSCLC patients with more than four BMs was non-inferior to SRS for those with one to four BMs in terms of OS and IPFS.
目前的循证指南支持对多达 4 个脑转移瘤（BMs）的患者进行立体定向放射外科治疗（SRS）。然而，对于 SRS 单独治疗的肿瘤数量仍存在争议。
本回顾性研究纳入了接受伽玛刀治疗作为脑病变初始治疗的非小细胞肺癌（NSCLC）伴 BMs 的患者。对患者进行随访以获取其生存信息。对结果进行统计学分析，比较<5 个 BMs 和≥5 个 BMs 组之间的生存差异，并确定预后因素。
共 77 例患者分为两组（<5 个 BMs 的 54 例患者和≥5 个 BMs 的 23 例患者）。<5 个 BMs 组的中位总生存期（OS）为 18.3 个月，≥5 个 BMs 组为 17.7 个月。<5 个 BMs 组的中位颅内无进展生存期（IPFS）为 9.0 个月，≥5 个 BMs 组为 9.9 个月。两组间 OS 和 IPFS 无显著差异。多变量分析表明，腺癌、原发性肿瘤控制、较高的 Karnofsky 表现量表（KPS）评分和挽救性治疗是有利于 OS 延长的独立预后因素。
对于 NSCLC 伴多个 BMs（>4 个）的患者，SRS 作为初始治疗与 SRS 治疗 1-4 个 BMs 的患者相比，在 OS 和 IPFS 方面无劣效性。
