Nakamura O, Matsutani M, Shitara N, Okamoto K, Kaneko M, Nakamura H, Asai A, Ueki K, Shimizu T, Tanaka Y
Department of Neurosurgery, Tokyo Metropolitan Komagome Hospital, Japan.
Acta Neurochir (Wien). 1994;131(1-2):91-6. doi: 10.1007/BF01401458.
In patients with brain metastasis from lung cancer, we have been able to control local recurrence in approximately 80% of cases. But many of them tend to show brain atrophy with mental deterioration developing a few months after whole brain radiation. To prevent brain atrophy, we have attempted treating patients, whose metastasis was diagnosed as single, by intra-operative radiotherapy (IOR) alone following surgical resection. Among 43 patients, 19 patients who had no metastases other than the brain metastases, were chosen as subjects for active treatment (surgical resection+IOR). Their 1-year survival rate was 75%. Fourteen out of 27 patients with brain metastases from lung cancer received active treatment and their 1-year survival rate was 74%. This result was not inferior to our result of 71 patients who received surgical resection and whole brain irradiation. When no preventive whole brain irradiation was performed, patients were observed every 8 weeks by CT scan in order to ascertain tumour recurrence limited to the treated site or appearance of any new metastatic lesion remote from the treated site. Among all 43 patients, local recurrence was recognized in 7 cases and remote recurrence was observed in 7 cases. Within 6 months, local and remote recurrence was found in 3 cases each. These results were almost the same as those for the usual therapy (surgery plus whole brain irradiation). If such a new lesion is detected, additional radiation can be performed with the possibility of achieving complete remission.
在肺癌脑转移患者中，我们已能够在约80%的病例中控制局部复发。但他们中的许多人在全脑放疗后几个月往往会出现脑萎缩并伴有精神衰退。为预防脑萎缩，我们尝试对那些转移灶被诊断为单发的患者，在手术切除后仅通过术中放疗（IOR）进行治疗。在43例患者中，选择19例除脑转移外无其他转移灶的患者作为积极治疗的对象（手术切除+IOR）。他们的1年生存率为75%。27例肺癌脑转移患者中有14例接受了积极治疗，其1年生存率为74%。这一结果并不逊于我们对71例接受手术切除和全脑照射患者的结果。当未进行预防性全脑照射时，每8周通过CT扫描观察患者，以确定肿瘤复发是否局限于治疗部位或是否出现远离治疗部位的任何新转移灶。在所有43例患者中，有7例出现局部复发，7例出现远处复发。在6个月内，局部和远处复发各有3例。这些结果与常规治疗（手术加全脑照射）的结果几乎相同。如果检测到这样的新病灶，可以进行额外的放疗，有可能实现完全缓解。
