Bindal R K, Sawaya R E, Leavens M E, Taylor S H, Guinee V F
Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston.
Neurosurgery. 1994 Aug;35(2):185-90; discussion 190-1. doi: 10.1227/00006123-199408000-00002.
We report on 21 patients surgically treated for intraparenchymal brain metastasis from sarcoma, including six osteosarcomas, four leiomyosarcomas, three malignant fibrous histiocytomas, two alveolar soft-part sarcomas, two Ewing's bone sarcomas, one extraskeletal osteosarcoma, one extraskeletal Ewing's sarcoma, and two unclassified sarcomas. Median survival after craniotomy was 11.8 months. Patients with a preoperative Karnofsky performance score of > 70 survived for 15.7 versus 6.6 months for those with a Karnofsky performance score < or = 70. Patients. undergoing complete resection survived 14.0 versus 6.2 months for patients undergoing incomplete resection. Patients with evidence of lung metastases at the time of surgery survived 11.8 months, which was similar to the 10.5-month survival for patients with disease limited to the brain. The two patients with alveolar soft-part sarcoma are alive at 16 and 25 months after surgery. We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain and that patients with metastasis from alveolar soft-part sarcoma may have a relatively good prognosis if they are surgically treated. The complete removal of all brain metastases and a Karnofsky performance score > 70 are associated with a favorable prognosis, whereas the presence of concurrent lung metastases is not a contraindication to surgery.
我们报告了21例因肉瘤脑实质内转移而接受手术治疗的患者，其中包括6例骨肉瘤、4例平滑肌肉瘤、3例恶性纤维组织细胞瘤、2例肺泡软组织肉瘤、2例尤因骨肉瘤、1例骨外骨肉瘤、1例骨外尤因肉瘤以及2例未分类肉瘤。开颅术后的中位生存期为11.8个月。术前卡诺夫斯基表现评分>70分的患者生存期为15.7个月，而评分≤70分的患者生存期为6.6个月。接受完整切除的患者生存期为14.0个月，而接受不完整切除的患者生存期为6.2个月。手术时存在肺转移证据的患者生存期为11.8个月，这与疾病局限于脑部的患者10.5个月的生存期相似。两名肺泡软组织肉瘤患者术后分别在16个月和25个月时仍存活。我们得出结论，手术对于治疗特定的肉瘤脑转移患者是有效的，并且肺泡软组织肉瘤转移患者如果接受手术治疗可能具有相对较好的预后。完全切除所有脑转移灶以及卡诺夫斯基表现评分>70分与良好的预后相关，而同时存在肺转移并非手术的禁忌证。
