Cairncross J G, Kim J H, Posner J B
Ann Neurol. 1980 Jun;7(6):529-41. doi: 10.1002/ana.410070606.
We treated 183 patients who had brain metastases with whole-brain radiation therapy (RT) and adrenocorticosteroids utilizing a new high-dose radiation protocol. Treatment produced neurological improvement in 135 patients (74%); there was no change in 37 (20%), and deterioration occurred in 11 (6%). Of those patients who improved, two-thirds maintained neurological improvement for the remainder of their lives or for at least nine months, and one-third relapsed. One-third of those who relapsed improved again with steroids or further RT. Clinical improvement paralleled tumor regression on CT scan. Despite the clinical response, median survival was only twelve weeks; 24% lived six months and 8% lived one year. Death resulted from progressive brain disease in 16% of the patients. Two-thirds of the patients died of advancing systemic disease in the setting of stable, improved neurological function. These data suggest that the majority of patients with brain metastases benefit from RT and that systemic cancer, not central nervous system disease, limits the length of life.
我们采用一种新的高剂量放射治疗方案，对183例脑转移患者进行了全脑放射治疗（RT）和肾上腺皮质类固醇治疗。治疗使135例患者（74%）的神经功能得到改善；37例（20%）无变化，11例（6%）病情恶化。在病情改善的患者中，三分之二在余生或至少九个月内保持神经功能改善，三分之一复发。三分之一复发的患者使用类固醇或进一步放疗后再次改善。临床改善与CT扫描上的肿瘤消退情况平行。尽管有临床反应，但中位生存期仅为12周；24%的患者存活6个月，8%的患者存活1年。16%的患者死于进行性脑疾病。三分之二的患者在神经功能稳定、改善的情况下死于全身性疾病进展。这些数据表明，大多数脑转移患者从放疗中获益，而全身性癌症而非中枢神经系统疾病限制了生存期。
