Cho K H, Hall W A, Gerbi B J, Higgins P D, Bohen M, Clark H B
Department of Therapeutic Radiology and Radiation Oncology, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA.
J Neurooncol. 1998 Oct;40(1):73-86. doi: 10.1023/a:1006169109920.
In this study we evaluate prognostic factors that predict local-regional control and survival following stereotactic radiosurgery (SRS) in patients with brain metastasis and establish guidelines for patient selection. Our evaluation is based on 73 patients with brain metastasis treated with SRS at the University of Minnesota between March 1991 and November 1995. The ability of stereotactic radiosurgery to improve local control in patients with brain metastases is confirmed in our study in which only 6 of 62 patients failed locally after SRS, with an actuarial local progression-free survival of 80% at 2 years. Variables that predicted worse prognosis were larger tumor size (p = 0.05) for local progression-free survival and multiplicity of metastasis (p = 0.03) and infratentorial location of metastases (p = 0.006) for regional progression-free survival. Absence of extracranial disease, KPS > or = 70, and single intracranial metastasis were significant predictors of longer survival. Patients who fulfill all three criteria will survive longer after SRS (MS = 17.7 months) and will most likely benefit from the increase local control in the brain achieved by SRS. Survival in patients who do not meet any of these criteria is very poor (MS = 1.5 months), and these patients are less likely to benefit from this treatment. Careful selection of patients for SRS is warranted.
在本研究中，我们评估了预测脑转移瘤患者立体定向放射外科治疗（SRS）后局部区域控制和生存情况的预后因素，并制定了患者选择指南。我们的评估基于1991年3月至1995年11月期间在明尼苏达大学接受SRS治疗的73例脑转移瘤患者。在我们的研究中，立体定向放射外科改善脑转移瘤患者局部控制的能力得到了证实，62例患者中只有6例在SRS后出现局部失败，2年的精算局部无进展生存率为80%。预测预后较差的变量包括局部无进展生存方面较大的肿瘤大小（p = 0.05），区域无进展生存方面转移灶的多发性（p = 0.03）和幕下转移灶位置（p = 0.006）。无颅外疾病、KPS≥70以及单发颅内转移是生存时间较长的显著预测因素。满足所有这三个标准的患者在SRS后生存时间更长（中位生存时间 = 17.7个月），并且最有可能从SRS实现的增强的脑局部控制中获益。不符合这些标准中任何一条的患者生存情况很差（中位生存时间 = 1.5个月），并且这些患者从这种治疗中获益的可能性较小。因此有必要仔细选择适合SRS治疗的患者。
