Departments of1Neurosurgery and.
2Radiation Oncology, Stanford University School of Medicine, Stanford, California.
Neurosurg Focus. 2023 Aug;55(2):E7. doi: 10.3171/2023.5.FOCUS23168.
Brain metastases (BMs) secondary to sarcoma are rare, and their incidence ranges from 1% to 8% of all bone and soft tissue sarcomas. Although stereotactic radiosurgery (SRS) is widely used for BMs, only a few papers have reported on SRS for sarcoma metastasizing to the brain. The purpose of this study was to evaluate the safety and effectiveness of SRS for sarcoma BM.
The authors retrospectively reviewed the clinical and radiological outcomes of patients with BM secondary to histopathologically confirmed sarcoma treated with SRS, either as primary treatment or as adjuvant therapy after surgery, at their institution between January 2005 and September 2022. They also compared the outcomes of patients with hemorrhagic lesions and of those without.
Twenty-three patients (9 females) with 150 BMs secondary to sarcoma were treated with CyberKnife SRS. Median age at the time of treatment was 48.22 years (range 4-76 years). The most common primary tumor sites were the heart, lungs, uterus, upper extremities, chest wall, and head and neck. The median Karnofsky Performance Status on presentation was 73.28 (range 40-100). Eight patients underwent SRS as a primary treatment and 15 as adjuvant therapy to the resection cavity. The median tumor volume was 24.1 cm3 (range 0.1-150.3 cm3), the median marginal dose was 24 Gy (range 18-30 Gy) delivered in a median of 1 fraction (range 1-5) to a median isodose line of 76%. The median follow-up was 8 months (range 2-40 months). Median progression-free survival and overall survival were 5.3 months (range 0.4-32 months) and 8.2 months (range 0.1-40), respectively. The 3-, 6-, and 12-month local tumor control (LTC) rates for all lesions were respectively 78%, 52%, and 30%. There were no radiation-induced adverse effects. LTC at the 3-, 6-, and 12-month follow-ups was better in patients without hemorrhagic lesions (100%, 70%, and 40%, respectively) than in those with hemorrhagic lesions (68%, 38%, and 23%, respectively).
SRS, both as a primary treatment and as adjuvant therapy to the resection cavity after surgery, is a safe and relatively effective treatment modality for sarcoma BMs. Nonhemorrhagic lesions show better LTC than hemorrhagic lesions. Larger studies aiming to validate these results are encouraged.
继发于肉瘤的脑转移瘤（BMs）较为罕见，其发生率占所有骨和软组织肉瘤的 1%至 8%。尽管立体定向放射外科（SRS）被广泛用于 BMs，但仅有少数文献报道了 SRS 治疗转移至脑部的肉瘤。本研究旨在评估 SRS 治疗肉瘤脑转移瘤的安全性和有效性。
作者回顾性分析了 2005 年 1 月至 2022 年 9 月期间，在其机构中，通过 SRS 治疗经组织病理学证实的肉瘤继发 BMs 的患者的临床和影像学结局。这些患者要么接受 SRS 作为原发性治疗，要么在手术后接受 SRS 作为辅助治疗。他们还比较了有出血性病变和无出血性病变患者的结局。
23 名女性患者共 150 个肉瘤脑转移瘤接受了 CyberKnife SRS 治疗。治疗时的中位年龄为 48.22 岁（范围为 4-76 岁）。最常见的原发肿瘤部位是心脏、肺部、子宫、上肢、胸壁和头颈部。就诊时的中位 Karnofsky 表现状态为 73.28（范围为 40-100）。8 名患者接受 SRS 作为原发性治疗，15 名患者接受 SRS 作为切除后辅助治疗。肿瘤体积中位数为 24.1cm3（范围为 0.1-150.3cm3），边缘剂量中位数为 24Gy（范围为 18-30Gy），采用 1 个分割（范围为 1-5），至 76%的等剂量线。中位随访时间为 8 个月（范围为 2-40 个月）。中位无进展生存期和总生存期分别为 5.3 个月（范围为 0.4-32 个月）和 8.2 个月（范围为 0.1-40 个月）。所有病变的 3、6 和 12 个月局部肿瘤控制（LTC）率分别为 78%、52%和 30%。无放射性不良反应。在无出血性病变的患者中，3、6 和 12 个月的 LTC 分别为 100%、70%和 40%，优于有出血性病变的患者（分别为 68%、38%和 23%）。
SRS 作为原发性治疗和手术后切除后辅助治疗，对肉瘤脑转移瘤是一种安全且相对有效的治疗方法。无出血性病变的 LTC 优于有出血性病变的 LTC。鼓励开展更大规模的研究来验证这些结果。
