Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan.
World Neurosurg. 2024 Mar;183:e944-e952. doi: 10.1016/j.wneu.2024.01.069. Epub 2024 Jan 19.
This study aimed to evaluate prognostic factors including pre-radiosurgical blood count in elderly patients (EPs) with brain metastasis (BM) who were treated using linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator.
Between January 2011 and November 2021, 101 consecutive EPs with BM were treated by LINAC-based SRS or fSRT using LINAC with a micro-multileaf collimator. EPs were defined as patients aged ≥75 years.
The tumors originated from the lungs (n = 90; 89.1%), colon (n = 2; 2.0%), and others (n = 9; 8.8%) in these EPs. The median pretreatment Karnofsky Performance Status was 80 (range, 40-100). The median follow-up time was 10 months (range, 0-76), as was the median survival. The 6-month, 1-year, and 2-year survival in the EP group was 58.3%, 43.2%, and 28.5%, respectively. Freedom from local failure at 6 months and 1 and 2 years was 97%, 95%, and 91.5%, respectively. Freedom from distant failure at 6 months and 1 and 2 years in EPs was 70.6%, 59.4%, and 54.2%, respectively. A high neutrophil/lymphocyte ratio >5.33 was an unfavorable predictor of prognosis for EPs with BMs treated with SRS and fSRT (P < 0.001). In the EPs, the prognostic factors associated with prolonged survival in the Cox proportional hazards model were being female and a good pretreatment Karnofsky Performance Status.
The findings of our study highlight the efficacy of LINAC-based SRS and fSRT with a micro-multileaf collimator in the treatment of EPs with BMs. Neutrophil/lymphocyte ratio can be an important factor in treatment decisions for EPs with BMs.
本研究旨在评估包括放射外科前血细胞计数在内的预后因素，这些因素涉及接受基于直线加速器（LINAC）的立体定向放射外科（SRS）和使用微多叶准直器的分割立体定向放射治疗（fSRT）的老年脑转移（BM）患者。
2011 年 1 月至 2021 年 11 月，101 例连续接受基于 LINAC 的 SRS 或 fSRT 治疗的老年 BM 患者，这些患者使用带有微多叶准直器的 LINAC。老年患者定义为年龄≥75 岁的患者。
这些老年患者的肿瘤来源于肺部（n=90；89.1%）、结肠（n=2；2.0%）和其他部位（n=9；8.8%）。预处理卡诺夫斯基表现状态的中位数为 80（范围，40-100）。中位随访时间为 10 个月（范围，0-76），中位生存期为 10 个月。老年患者组的 6 个月、1 年和 2 年生存率分别为 58.3%、43.2%和 28.5%。6 个月、1 年和 2 年局部无失败率分别为 97%、95%和 91.5%。老年患者 6 个月、1 年和 2 年远处无失败率分别为 70.6%、59.4%和 54.2%。高中性粒细胞/淋巴细胞比值>5.33 是 SRS 和 fSRT 治疗老年 BM 患者预后不良的预测因素（P<0.001）。在老年患者中，Cox 比例风险模型中与生存时间延长相关的预后因素是女性和良好的预处理卡诺夫斯基表现状态。
本研究结果强调了基于 LINAC 的 SRS 和 fSRT 联合微多叶准直器治疗老年 BM 患者的疗效。中性粒细胞/淋巴细胞比值可能是老年 BM 患者治疗决策的重要因素。
