Stereotactic radiosurgery for cerebral metastatic melanoma: Factors affecting local disease control and survival
Stereotactic radiosurgery for cerebral metastatic melanoma: Factors affecting local disease control and survival
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DOI：
10.1016/s0360-3016(98)00272-7
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发表时间：
1998-10-01
影响因子：
7
通讯作者：
Lunsford, LD
中科院分区：
文献类型：
--
作者：
Mori, Y;Kondziolka, D;Lunsford, LD
目的：脑转移的发生对于恶性黑色素瘤患者来说是一个不祥的事件。我们评估了转移性黑色素瘤患者立体定向放射外科 (SR) 后的结果，以确定患者的治疗结果和生存因素。方法：作者回顾了 60 名连续 60 名黑色素瘤转移患者（总共 118 例黑色素瘤脑转移）在 9 年间隔期间接受 SR 的治疗结果。其中，51 例还接受了全脑放射治疗（WBRT），总共 118 个平均体积为 2.95 ml（范围，0.1-25.5 ml）的肿瘤接受了 SR 治疗，平均边缘剂量为 16.4 Gy（范围，10 至 20 Gy）。采用单变量和多变量分析确定影响 60 例患者生存的显着预后因素。 结果：中位生存期为所有 60 名患者均接受 SR 7 个月，脑肿瘤诊断后 10 个月（平均随访时间为 9.3 个月）。多变量分析显示，缺乏活动性全身性疾病和孤立性转移与生存率提高相关（中位生存期为 15 个月）。可评价肿瘤（n = 72）的影像学定义局部控制率为 90%（消失 = 11%，缩小 = 44%，稳定 = 35%），7 名患者出现局部复发，14 名患者出现远端脑部疾病。 WBRT 联合放射外科治疗并不能提高生存率，也不能改善局部肿瘤控制。当 SR 中加入 WBRT 时，新的脑转移发生率较低（23% 比 44%），但这种差异并不显着。只有 4 名患者 (7%) 死于放射外科治疗的肿瘤进展。没有患者出现迟发性放射相关并发症，但 3 例患者在放射外科手术部位出现迟发性瘤内出血，其中 2 例出现新症状。结论：立体定向放射外科治疗黑色素瘤脑转移有效且并发症少，单独使用放射外科治疗对于许多孤立性肿瘤患者来说是一种合适的治疗策略。 (C) 1998 爱思唯尔科学公司。
Purpose: The development of a brain metastasis represents an ominous event for patients with malignant melanoma. We evaluated results after stereotactic radiosurgery (SR) for patients with metastastic melanoma to identify patient outcomes and factors for survival.Methods: The authors reviewed the management results of 60 consecutive patients with melanoma metastases, with a total of 118 melanoma brain metastases, undergoing SR during a 9-year interval. Of these, 51 also had whole-brain radiation therapy (WBRT), A total of 118 tumors of mean volume of 2.95 ml (range, 0.1-25.5 ml) were treated by SR with a mean margin dose of 16.4 Gy (range, 10 to 20 Gy), Univariate and multivariate analyses were used to determine significant prognostic factors affecting survival in 60 patients.Results: Median survival was 7 months after SR in all 60 patients and 10 months from brain tumor diagnosis (mean follow-up period, 9.3 months). Lack of active systemic disease and a solitary metastasis were associated with improved survival in multivariate analysis (median, 15 months). The imaging-defined local control rate of evaluable tumors (n = 72) was 90% (disappearance = 11%, shrinkage = 44%, and stable = 35%), Local recurrence developed in 7 patients and remote brain disease developed in 14 patients. WBRT combined with radiosurgery did not improve survival nor local tumor control, New brain metastases developed less often when WBRT was added to SR (23% vs. 44%), but this difference was not significant. Only 4 patients (7%) died from progression of a radiosurgery-managed tumor. No patient developed a delayed radiation-related complication, but 3 patients developed delayed intratumoral hemorrhage at the radiosurgery site, 2 of whom had new symptoms.Conclusions: Stereotactic radiosurgery for melanoma brain metastasis is effective and is associated with few complications, The use of radiosurgery alone is an appropriate management strategy for many patients with solitary tumors. (C) 1998 Elsevier Science Inc.