Jiani Sherry Liu, Karlsson Bengt, Vellayappan Balamurugan, Ang Yvonne, Wu Peng, Yeo Tseng Tsai, Nga Vincent
Department of Surgery, Division of Neurosurgery, National University Hospital, Singapore, Singapore.
Department of Radiation Oncology, National University Hospital, Singapore, Singapore.
Neurooncol Adv. 2024 Mar 27;6(1):vdae047. doi: 10.1093/noajnl/vdae047. eCollection 2024 Jan-Dec.
The importance of the number of brain metastases (BM) when deciding between whole brain radiation treatment (WBRT) and radiosurgery is controversial. We hypothesized that the number of BM is of limited importance when deciding radiation strategy, and offered Gamma Knife surgery (GKS) also for selected patients with 20 or more BM.
The outcome following single session GKS for 75 consecutive patients harboring 20 or more (20+) BM was analyzed. Data was collected both retro- and prospectively.
The median survival time was 9 months. Two grade 3 complications occurred, 1 resolved and 1 did not. Sex and clinical condition at the time of GKS (ECOG value) were the only parameters significantly related to survival time. Eighteen patients developed leptomeningeal dissemination with or without distant recurrences (DR), and another 32 patients developed DR a total of 73 times. DR was managed with GKS 24 times, with WBRT 3 times and with systemic treatment or best supportive care 46 times. The median time to developing DR was unrelated to the number of BM, but significantly longer for patients older than 65 years, as well as for patients with NSCLC.
GKS is a reasonable treatment option for selected patients with 20 or more BM. It is better to decide the optimal management of post-GKS intracranial disease progression once it occurs rather than trying to prevent it by using adjunct WBRT.
在决定采用全脑放射治疗（WBRT）还是放射外科手术时，脑转移瘤（BM）数量的重要性存在争议。我们假设在决定放射治疗策略时，BM数量的重要性有限，并为部分有20个或更多BM的患者提供了伽玛刀手术（GKS）。
分析了连续75例有20个或更多（20+）BM的患者单次接受GKS后的结果。数据通过回顾性和前瞻性方式收集。
中位生存时间为9个月。发生了2例3级并发症，1例缓解，1例未缓解。GKS时的性别和临床状况（东部肿瘤协作组[ECOG]评分）是与生存时间显著相关的唯一参数。18例患者出现了软脑膜播散，伴或不伴有远处复发（DR），另有32例患者共发生73次DR。DR采用GKS治疗24次，采用WBRT治疗3次，采用全身治疗或最佳支持治疗46次。发生DR的中位时间与BM数量无关，但65岁以上患者以及非小细胞肺癌（NSCLC）患者的时间显著更长。
对于部分有20个或更多BM的患者，GKS是一种合理的治疗选择。最好在GKS后颅内疾病进展发生时决定最佳治疗方案，而不是试图通过辅助WBRT来预防。
