Williams J, Enger C, Wharam M, Tsai D, Brem H
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-8811, USA.
J Neurooncol. 1998 Mar;37(1):79-85. doi: 10.1023/a:1005958215384.
In the medical literature, stereotactic radiosurgery (SRS) for brain metastases results in rates of local control of 65 to 85 %. To define patient selection criteria, we measured the survival in a population with a high proportion of non-small cell lung carcinoma (NCS lung) metastases that occurred soon after primary diagnosis. Between 9/89 and 10/93 30 adults (21 M, 9 F) had SRS for metastatic NSC lung carcinoma (14 patients) vs. non-lung carcinomas (16 patients having breast (3), renal (3), melanoma (3), GI (2, thyroid (1) or carcinoma of unknown origin (4)). The metastases were solitary for 22 patients and multiple for 8 patients. Average ages (y) (+/-SD) were 58.6+/-10.4 for NSC lung patients and 53.4+/-12.5 (p = 0.32) for non-lung patients. The average interval (months) from diagnosis of the primary to metastasis was 23.8+/-41.4 for all patients. This interval was shorter for NSC lung patients: 3.1+/-6.0 vs. 48.0+/-51.7 (p < 0.001) for non-lung patients. Twenty seven patients had conventional radiotherapy (XRT) before (24 patients) or after (3 patients) SRS. Doses (cGy) were 3303+/-841 for 13 NSC lung patients and 4256+/-992 for 14 non-lung patients (p = 0.034). The median time from primary diagnosis to SRS was shorter for the NSC lung patients (11 mo) compared to the non-lung patients (35 mo). SRS was given for recurrence of metastases after XRT for 11/14 NSC lung patients and 13/16 non-lung patients. The doses (cGy) of SRS were 1579+/-484 vs. 1682+/-476 (p=0.45) for the NSC lung and non-lung groups, respectively. After SRS a decrease in metastasis diameter was observed in 10 of 14 NSC lung patients vs. 12 of 16 non-lung patients (p=0.85 Chi-square). Twenty-seven of the 30 patients have died. For all patients, the median survival after diagnosis of the primary and after radiosurgery was 31.3 and 8.4 months, respectively. The median survival (95% CI) from primary diagnosis was 24.3 months (13.2-27.3) for NSC lung patients and 46.5 months (39.2-65.5) for non-lung patients (p=0.005 logrank test). The median survival (95% CI) after SRS was 7.9 months (3.0-14.3) for the NSC lung patients and 8.4 (2.9-11.9) months for the non-lung patients (p=0.98 logrank test). Within the two groups, no difference in survival was observed for patients who had SRS sooner (< 1 yr for NSC lung; < 3 yr for non-lung) after primary diagnosis: 9.3 vs. 6.5 mo for NSC lung (p=0.21) and 10.5 vs. 7.2 mo for non-lung (p=0.87). In this series, the shortened intervals from primary diagnosis to SRS for NSC lung metastases was associated with post-SRS survivorship that was equivalent to the more favorable non-lung group.
在医学文献中，立体定向放射外科治疗（SRS）脑转移瘤的局部控制率为65%至85%。为了确定患者选择标准，我们测量了一组非小细胞肺癌（NSC肺癌）转移比例较高且在初次诊断后不久发生转移的患者的生存期。在1989年9月至1993年10月期间，30名成年人（21名男性，9名女性）因转移性NSC肺癌（14例患者）或非肺癌（16例患者，包括乳腺癌（3例）、肾癌（3例）、黑色素瘤（3例）、胃肠道癌（2例）、甲状腺癌（1例）或不明来源癌（4例））接受了SRS治疗。22例患者的转移灶为单发，8例患者为多发。NSC肺癌患者的平均年龄（岁）（±标准差）为58.6±10.4，非肺癌患者为53.4±12.5（p = 0.32）。所有患者从原发性肿瘤诊断到转移的平均间隔时间（月）为23.8±41.4。NSC肺癌患者的这一间隔时间较短：3.1±6.0个月，而非肺癌患者为48.0±51.7个月（p < 0.001）。27例患者在SRS之前（24例患者）或之后（3例患者）接受了传统放疗（XRT）。13例NSC肺癌患者的放疗剂量（cGy）为3303±841，14例非肺癌患者为4256±992（p = 0.034）。与非肺癌患者（35个月）相比，NSC肺癌患者从原发性肿瘤诊断到SRS的中位时间较短（11个月）。11/14例NSC肺癌患者和13/16例非肺癌患者因转移瘤复发在XRT后接受了SRS治疗。NSC肺癌组和非肺癌组SRS的剂量（cGy）分别为1579±484和1682±476（p = 0.45）。SRS后，14例NSC肺癌患者中有10例转移瘤直径减小，16例非肺癌患者中有12例（p = 0.85，卡方检验）。30例患者中有27例死亡。对于所有患者，原发性肿瘤诊断后和放射外科治疗后的中位生存期分别为31.3个月和8.4个月。NSC肺癌患者从原发性肿瘤诊断的中位生存期（95%CI）为24.3个月（13.2 - 27.3），非肺癌患者为46.5个月（39.2 - 65.5）（p = 0.005，对数秩检验）。NSC肺癌患者SRS后的中位生存期（95%CI）为7.9个月（3.0 - 14.3），非肺癌患者为8.4个月（2.9 - 11.9）（p = 0.98，对数秩检验）。在两组中，原发性肿瘤诊断后较早接受SRS治疗的患者（NSC肺癌患者<1年；非肺癌患者<3年）的生存期无差异：NSC肺癌患者为9.3个月对6.5个月（p = 0.21），非肺癌患者为10.5个月对7.2个月（p = 0.87）。在本系列研究中，NSC肺癌转移灶从原发性肿瘤诊断到SRS的间隔时间缩短与SRS后生存期相关，该生存期与更有利的非肺癌组相当。
