Fernandez-Vicioso E, Suh J H, Kupelian P A, Sohn J W, Barnett G H
Department of Radiation Oncology, Cleveland Clinic Foundation, Ohio 44195 USA.
Radiat Oncol Investig. 1997;5(1):31-7. doi: 10.1002/(SICI)1520-6823(1997)5:1<31::AID-ROI5>3.0.CO;2-L.
To evaluate and define treatment prognostic factors and selection criteria for patients with solitary brain metastasis treated with stereotactic radiosurgery. Between March 1990 and January 1995, 48 patients with solitary brain metastasis were treated with stereotactic radiosurgery at our tertiary care institution. Eleven patients were treated for progression or relapse of intracranial disease after whole-brain external beam radiotherapy or surgical resection. Patients were eligible for radiosurgery if they had a (1) Karnofsky Performance Status (KPS) of at least 70, (2) a solitary, radiographically distinct lesion < 4 cm in diameter, (3) lesion at least 1 cm from the optic chiasm, and (4) a reasonably well-controlled primary tumor. The factors subjected to univariate and multivariate analysis for local control and survival correlations were age, histology, control of systemic disease, surgical debulking, whole-brain irradiation, dose delivered, lesion volume, location (supratentorial vs. infratentorial), and new versus recurrent metastasis. Sex and initial KPS were also analyzed for survival. Local control was achieved in 39 (81%) patients. The only prognostic factor in the univariate analysis that significantly correlated with local control was new versus recurrent lesion (P = .009). Initial KPS of at least 80 and age < 65 years were significant with regard to survival in the univariate and multivariate analyses. Median survival after radiosurgery was 8 months. This study corroborates the usefulness of stereotactic radiosurgery for patients with a small solitary metastatic brain lesion. In our series, as well as in others, several characteristics (young age, optimal KPS, newly diagnosed metastasis, controlled or absent systemic disease) provide clues as to which patients will most benefit. Studies, including randomized trials, are needed to clarify patient and tumour characteristics that predict which patients will benefit from stereotactic radiosurgery.
评估并确定接受立体定向放射外科治疗的孤立性脑转移瘤患者的治疗预后因素及选择标准。1990年3月至1995年1月期间，我们的三级医疗机构对48例孤立性脑转移瘤患者进行了立体定向放射外科治疗。11例患者在接受全脑外照射放疗或手术切除后因颅内疾病进展或复发而接受治疗。符合以下条件的患者可接受放射外科治疗：（1）卡氏功能状态评分（KPS）至少为70分；（2）孤立的、影像学上清晰的直径<4 cm的病灶；（3）病灶距视交叉至少1 cm；（4）原发肿瘤得到合理控制。对局部控制和生存相关性进行单因素和多因素分析的因素包括年龄、组织学类型、全身疾病控制情况、手术减瘤、全脑照射、给予的剂量、病灶体积、位置（幕上与幕下）以及新发转移与复发转移。还对性别和初始KPS进行了生存分析。39例（81%）患者实现了局部控制。单因素分析中与局部控制显著相关的唯一预后因素是新发病灶与复发病灶（P = 0.009）。在单因素和多因素分析中，初始KPS至少为80分以及年龄<65岁对生存有显著意义。放射外科治疗后的中位生存期为8个月。本研究证实了立体定向放射外科治疗对小的孤立性脑转移瘤患者的有效性。在我们的系列研究以及其他研究中，一些特征（年轻、最佳KPS、新诊断的转移瘤、全身疾病得到控制或无全身疾病）为哪些患者将最受益提供了线索。需要开展包括随机试验在内的研究，以明确预测哪些患者将从立体定向放射外科治疗中获益的患者和肿瘤特征。
