Noordijk E M, Vecht C J, Haaxma-Reiche H, Padberg G W, Voormolen J H, Hoekstra F H, Tans J T, Lambooij N, Metsaars J A, Wattendorff A R
Department of Radiation Oncology, University Hospital Leiden, The Netherlands.
Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):711-7. doi: 10.1016/0360-3016(94)90558-4.
To determine if in patients with single brain metastasis the addition of neurosurgery to radiotherapy leads to lengthening of survival or to better quality of life.
From 1985 to 1990, 66 patients with single brain metastasis from a solid tumor were entered in a randomized trial of neurosurgery plus radiotherapy vs. radiotherapy alone. Patients were stratified for lung cancer vs. other sites of cancer and for progressive vs. stable systemic cancer. Radiotherapy was given to the whole brain by a novel scheme of two fractions of 2 Gy per day for a total dose of 40 Gy in 2 weeks, to obtain a relatively high total dose and short overall time, with minimal risk of late damage to normal tissue in long-term survivors.
In the whole group of 63 evaluable patients, both with lung cancer as with other tumors, the combined treatment led to a better duration of survival (median 10 vs. 6 months; p = 0.04). The largest difference between both treatment arms was observed in patients with inactive extracranial disease (median 12 vs. 7 months; p = 0.02). Patients with active extracranial disease had an equal median survival of only 5 months, irrespective of given treatment. Age proved to be a strong and independent prognostic factor: patients older than 60 years had a hazard ratio of dying of 2.74 (p = 0.003) compared with younger patients. Following treatment, most patients remained functionally independent until a few weeks before death. In the majority of patients the cause of death was systemic tumor progression.
Patients with single brain metastasis and with controlled or absent extracranial tumor activity should be treated with surgery and radiotherapy, especially when they are younger than 60 years. For patients with progressive extracranial disease, radiotherapy alone seems to be sufficient. The accelerated radiotherapy scheme of 40 Gy in 2 weeks to the whole brain is tolerated well and should also be considered for patients in a good performance status with surgically unaccessible single metastasis or even with multiple brain metastases.
确定在单发脑转移瘤患者中，放疗联合神经外科手术是否能延长生存期或改善生活质量。
1985年至1990年，66例来自实体瘤的单发脑转移瘤患者进入一项随机试验，比较神经外科手术加放疗与单纯放疗的效果。患者按肺癌与其他癌症部位以及全身性癌症进展与否进行分层。采用一种新的放疗方案，每天分两次给予全脑2 Gy，两周内总剂量达40 Gy，以获得相对较高的总剂量和较短的总疗程，同时将长期存活者正常组织发生晚期损伤的风险降至最低。
在63例可评估患者的整个队列中，无论是肺癌患者还是其他肿瘤患者，联合治疗均能带来更好的生存期（中位生存期10个月对6个月；p = 0.04）。在颅外疾病无活动的患者中，观察到两种治疗组之间的最大差异（中位生存期12个月对7个月；p = 0.02）。无论接受何种治疗，颅外疾病有活动的患者中位生存期均仅为5个月。年龄被证明是一个强大且独立的预后因素：60岁以上患者与年轻患者相比，死亡风险比为2.74（p = 0.003）。治疗后，大多数患者在死亡前几周仍保持功能独立。大多数患者的死亡原因是全身性肿瘤进展。
单发脑转移瘤且颅外肿瘤活动得到控制或不存在的患者，应接受手术和放疗，尤其是年龄小于60岁的患者。对于颅外疾病进展的患者，单纯放疗似乎就足够了。两周内给予全脑40 Gy的加速放疗方案耐受性良好，对于身体状况良好、手术无法切除的单发转移瘤甚至多发脑转移瘤患者也应考虑采用。
