Pirzkall A, Debus J, Lohr F, Fuss M, Rhein B, Engenhart-Cabillic R, Wannenmacher M
Department of Radiation Oncology, University of Heidelberg, Germany.
J Clin Oncol. 1998 Nov;16(11):3563-9. doi: 10.1200/JCO.1998.16.11.3563.
Evaluation of the treatment outcome after radiosurgery (RS) alone or in combination with whole-brain radiotherapy (WBRT) with special attention to prescribed dose and its influence on local control and survival.
Between September 1984 and January 1997, 236 patients with 311 brain metastases treated with radiosurgery met the following inclusion criteria: one to three brain metastases per patient; no previous WBRT; and Kamofsky performance status (KPS) > or = 50%. One hundred fifty-eight patients treated only with RS received a median dose of 20 Gy prescribed to the 80% isodose line; 78 patients received RS with a median dose of 15 Gy/80% and an additional course of WBRT.
For the entire series, overall median survival was 5.5 months, with control of CNS disease achieved in 92% of the treated brain metastases; the results were not significantly different between patients treated by RS with or without WBRT. However, in patients without evidence of extracranial disease, median survival was increased for patients who received WBRT (15.4 vs 8.3 months; P=.08). Additionally, there was a suggestion that increased doses for patients treated with RS only resulted in improved outcome. Four lesions were suspicious for radiation necrosis by magnetic resonance imaging (MRI); in one of the four lesions, radiation necrosis was confirmed histologically. The incidence of transient low-grade toxicity was 18%; symptoms could be treated by the temporary administration of steroids.
RS is an effective, noninvasive means of controlling brain metastases when used alone or in combination with WBRT. There is a trend for superior local control and especially in patients without extracranial disease for superior survival when RS is used in conjunction with WBRT. Randomized trials would seem to be warranted, comparing the benefit of RS with or without additional WBRT.
评估单纯放射外科治疗（RS）或联合全脑放疗（WBRT）后的治疗效果，特别关注处方剂量及其对局部控制和生存的影响。
1984年9月至1997年1月期间，236例接受放射外科治疗的311例脑转移瘤患者符合以下纳入标准：每位患者有1至3个脑转移瘤；既往未接受过WBRT；卡氏功能状态（KPS）≥50%。158例仅接受RS治疗的患者，给予80%等剂量线处的中位剂量为20 Gy；78例患者接受RS治疗，中位剂量为15 Gy/80%，并追加一个疗程的WBRT。
对于整个系列，总体中位生存期为5.5个月，92%的治疗脑转移瘤实现了中枢神经系统疾病的控制；接受或未接受WBRT的RS治疗患者的结果无显著差异。然而，在无颅外疾病证据的患者中，接受WBRT的患者中位生存期延长（15.4个月对8.3个月；P = 0.08）。此外，有迹象表明，仅接受RS治疗的患者增加剂量可改善预后。通过磁共振成像（MRI）发现4个病灶疑似放射性坏死；4个病灶中的1个经组织学证实为放射性坏死。短暂性低级别毒性的发生率为18%；症状可通过临时给予类固醇治疗。
RS单独使用或与WBRT联合使用时，是控制脑转移瘤的有效、非侵入性手段。当RS与WBRT联合使用时，局部控制有改善趋势，尤其是在无颅外疾病的患者中生存情况更佳。似乎有必要进行随机试验，比较RS联合或不联合额外WBRT的益处。
