Breneman J C, Warnick R E, Albright R E, Kukiatinant N, Shaw J, Armin D, Tew J
Division of Radiation Oncology, University of Cincinnati Medical Center, Ohio 45267-0757, USA.
Cancer. 1997 Feb 1;79(3):551-7. doi: 10.1002/(sici)1097-0142(19970201)79:3<551::aid-cncr18>3.0.co;2-2.
Stereotactic radiosurgery is being used with increasing frequency for the treatment of brain metastases. Optimal patient selection and treatment factors continue to be defined. This study provides outcome data from a single institutional experience with radiosurgery and identifies parameters that may be useful for the proper selection and treatment of patients.
Eighty-four patients underwent stereotactic radiosurgery for brain metastases between September 1989 and November 1995. Seventy-nine patients (93%) were treated at recurrence after previous whole brain radiotherapy. Patients had between 1 and 6 lesions treated with a median minimum tumor dose of 1600 centigrays (cGy). Thirty-eight patients (45%) had active extracranial disease at the time of radiosurgery.
Median survival for the entire group was 43 weeks from the date of radiosurgery and 71 weeks from the original diagnosis of brain metastases. Patients with 1 or 2 metastases had significantly improved survival compared with patients with > or = 3 metastases (P = 0.02), and patients without active extracranial tumor survived longer than those with extracranial disease (P = 0.03). Median time to failure for 145 evaluable lesions was 35 weeks. Local control was significantly improved for radiosurgery doses of > 1800 cGy, and for melanoma histology.
These results are comparable to reports of patients treated with resection and significantly superior to results observed after whole brain radiotherapy. The authors conclude that stereotactic radiosurgery is an effective, low risk treatment for extending the survival of patients with recurrent brain metastasis. Although survival is best for patients with < or = two lesions and no active extracranial disease, selected patients with > two lesions or active extracranial tumor may benefit as well.
立体定向放射外科在脑转移瘤治疗中的应用频率日益增加。最佳的患者选择和治疗因素仍在不断明确。本研究提供了单一机构放射外科治疗的结果数据，并确定了可能有助于正确选择和治疗患者的参数。
1989年9月至1995年11月期间，84例患者接受了立体定向放射外科治疗脑转移瘤。79例患者（93%）在先前全脑放疗后复发时接受治疗。患者有1至6个病灶接受治疗，中位最小肿瘤剂量为1600厘戈瑞（cGy）。38例患者（45%）在放射外科治疗时伴有活跃的颅外疾病。
整个组的中位生存期从放射外科治疗日期起为43周，从脑转移瘤最初诊断起为71周。有1或2个转移灶的患者与有≥3个转移灶的患者相比，生存期显著改善（P = 0.02），无活跃颅外肿瘤的患者比有颅外疾病的患者生存期更长（P = 0.03）。145个可评估病灶的中位失败时间为35周。对于放射外科剂量>1800 cGy以及黑色素瘤组织学类型，局部控制显著改善。
这些结果与手术切除治疗患者的报告相当，且明显优于全脑放疗后的结果。作者得出结论，立体定向放射外科是一种有效、低风险的治疗方法，可延长复发性脑转移瘤患者的生存期。虽然对于病灶≤两个且无活跃颅外疾病的患者生存期最佳，但部分有>两个病灶或活跃颅外肿瘤的患者也可能受益。
