Radiosurgery for Large Brain Metastases
Radiosurgery for Large Brain Metastases
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DOI：
10.1016/j.ijrobp.2011.06.1965
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发表时间：
2012-05-01
影响因子：
7
通讯作者：
Jung, Hee-Won
中科院分区：
文献类型：
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作者：
Han, Jung Ho;Kim, Dong Gyu;Jung, Hee-Won
目的：为了确定放射外科治疗脑转移瘤的有效性和安全性，在1998年至2009年期间，80例脑转移瘤（>14 cm（3））患者接受了放射外科治疗。平均年龄为59 ± 11岁，49例（61.3%）为男性。77例患者（96.3%）有神经系统症状，30例（37.5%）表现出依赖性功能状态。36例（45.0%）原发病得到控制，44例（55.0%）为单发病灶。平均肿瘤体积为22.4 +/- 8.8 cm（3），平均边缘剂量为13.8 +/- 2.2戈伊。结果：放疗后中位生存时间为7.9个月（95%可信区间[CI]，5.343-10.46），1年生存率为39.2%。48例（60.0%）和20例（25.0%）患者在放射外科手术后1-4个月内观察到功能改善或维持初始独立状态。原发病的控制、>= 11戈伊的边缘剂量和>= 26厘米（3）的肿瘤体积与总生存率显着相关（风险比，0.479; p = 0.018; 95% CI，0.261-0.880;风险比，0.350; p = 0.004; 95% CI，0.171-0.718;风险比，2.307; p = 0.006; 95%CI，分别为1.274-4.180）。不可接受的放射相关毒性（放射毒性肿瘤组中枢神经系统毒性3级，4级和5级，分别在7，6和2例患者）开发15例（18.8%）。结论：放射外科手术似乎有相当的疗效与手术治疗脑转移瘤。然而，在决定治疗方式时，应考虑放射外科手术后放射相关毒性的发生率。(C)2012 Elsevier Inc.
Purpose: To determine the efficacy and safety of radiosurgery in patients with large brain metastases treated with radiosurgery.Patients and Methods: Eighty patients with large brain metastases (>14 cm(3)) were treated with radiosurgery between 1998 and 2009. The mean age was 59 +/- 11 years, and 49 (61.3%) were men. Neurologic symptoms were identified in 77 patients (96.3%), and 30 (37.5%) exhibited a dependent functional status. The primary disease was under control in 36 patients (45.0%), and 44 (55.0%) had a single lesion. The mean tumor volume was 22.4 +/- 8.8 cm(3), and the mean marginal dose prescribed was 13.8 +/- 2.2 Gy.Results: The median survival time from radiosurgery was 7.9 months (95% confidence interval [CI], 5.343-10.46), and the 1-year survival rate was 39.2%. Functional improvement within 1-4 months or the maintenance of the initial independent status was observed in 48 (60.0%) and 20 (25.0%) patients after radiosurgery, respectively. Control of the primary disease, a marginal dose of >= 11 Gy, and a tumor volume >= 26 cm(3) were significantly associated with overall survival (hazard ratio, 0.479; p = .018; 95% CI, 0.261-0.880; hazard ratio, 0.350; p = .004; 95% CI, 0.171-0.718; hazard ratio, 2.307; p = .006; 95% CI, 1.274-4.180, respectively). Unacceptable radiation-related toxicities (Radiation Toxicity Oncology Group central nervous system toxicity Grade 3, 4, and 5 in 7, 6, and 2 patients, respectively) developed in 15 patients (18.8%).Conclusion: Radiosurgery seems to have a comparable efficacy with surgery for large brain metastases. However, the rate of radiation-related toxicities after radiosurgery should be considered when deciding on a treatment modality. (C) 2012 Elsevier Inc.