Salvati M, Cervoni L, Caruso R, Gagliardi F M, Delfini R
Department of Neurosurgery, Neurological Mediterranean Neuromed Institute, IRCCS, Pozzilli (IS), Italy.
Surg Neurol. 1998 Apr;49(4):441-4. doi: 10.1016/s0090-3019(97)00034-7.
We report on 15 patients surgically treated for intraparenchymal brain metastases from sarcoma, including six osteosarcomas, five leiomyosarcomas, two malignant fibrous histiocytomas, and two alveolar soft-part sarcomas (ASPS).
Median survival after craniotomy was 9.3 months. Patients with a preoperative Karnofsky performance score of > 70 survived for 12.8 versus 5.3 months for those with a Karnofsky performance score < 70 (p=0.03). Patients with evidence of only lung metastases at the time of surgery (nine cases) survived 8.6 months, which was similar to the 10.4-month survival for patients with disease limited to the brain (p=0.1). The two patients with alveolar soft-part sarcomas are alive at 15 and 20 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 ASPS 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; the presence of concurrent lung metastases is not a contraindication to surgery.
我们报告了15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、5例平滑肌肉瘤、2例恶性纤维组织细胞瘤和2例肺泡软组织肉瘤（ASPS）。
开颅术后的中位生存期为9.3个月。术前卡诺夫斯基功能状态评分>70的患者生存期为12.8个月，而评分<70的患者生存期为5.3个月（p=0.03）。手术时仅有肺转移证据的患者（9例）生存期为8.6个月，与疾病局限于脑部的患者10.4个月的生存期相似（p=0.1）。两名肺泡软组织肉瘤患者术后15个月和20个月仍存活。
我们得出结论，手术对于治疗特定的肉瘤脑转移患者有效，并且ASPS转移患者如果接受手术治疗可能预后相对较好。完全切除所有脑转移灶和卡诺夫斯基功能状态评分>70与良好预后相关；同时存在肺转移并非手术禁忌证。
