The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery.
The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery.
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DOI：
10.3171/2012.2.jns111353
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发表时间：
2012-05
影响因子：
4.1
通讯作者：
Ellis TL
中科院分区：
文献类型：
--
作者：
Cochran DC;Chan MD;Aklilu M;Lovato JF;Alphonse NK;Bourland JD;Urbanic JJ;McMullen KP;Shaw EG;Tatter SB;Ellis TL
伽玛刀手术（GKS）已被报道为治疗肾细胞癌（RCC）脑转移瘤的有效方法。作者旨在确定靶向药物如酪氨酸激酶抑制剂、哺乳动物雷帕霉素靶点抑制剂和贝伐单抗是否影响GKS后RCC的失败模式。在1999年至2010年期间，61例RCC脑转移患者接受了GKS治疗。对每个转移灶的边缘规定中位剂量为20戈伊（范围13-24戈伊）。Kaplan-Meier分析用于确定局部控制、远端失败和总生存率。进行考克斯比例风险回归以确定疾病相关因素与生存率之间的关系。1年、2年和3年的总生存率分别为38%、17%和9%。1年、2年和3年时无局部失败率分别为74%、61%和40%。1年、2年和3年的远端失败率分别为51%、79%和89%。27%的患者死于神经系统疾病。接受靶向药物治疗的患者（n = 24）的中位生存期为16.6个月，而未接受靶向治疗的患者（n = 37）的中位生存期为7.2个月（p = 0.04）。接受和未接受靶向药物治疗的患者1年时无局部失败率分别为93%和60%（p = 0.01）。多变量分析显示，使用靶向药物（风险比3.02，p = 0.003）是预测生存率提高的唯一因素。2例患者在治疗体积内发生GKS后出血。靶向药物似乎可以改善GKS治疗恶性肾细胞癌患者的局部控制和总生存率。
Gamma Knife surgery (GKS) has been reported as an effective modality for treating brain metastases from renal cell carcinoma (RCC). The authors aimed to determine if targeted agents such as tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and bevacizumab affect the patterns of failure of RCC after GKS. Between 1999 and 2010, 61 patients with brain metastases from RCC were treated with GKS. A median dose of 20 Gy (range 13–24 Gy) was prescribed to the margin of each metastasis. Kaplan-Meier analysis was used to determine local control, distant failure, and overall survival rates. Cox proportional hazard regression was performed to determine the association between disease-related factors and survival. Overall survival at 1, 2, and 3 years was 38%, 17%, and 9%, respectively. Freedom from local failure at 1, 2, and 3 years was 74%, 61%, and 40%, respectively. The distant failure rate at 1, 2, and 3 years was 51%, 79%, and 89%, respectively. Twenty-seven percent of patients died of neurological disease. The median survival for patients receiving targeted agents (n = 24) was 16.6 months compared with 7.2 months (n = 37) for those not receiving targeted therapy (p = 0.04). Freedom from local failure at 1 year was 93% versus 60% for patients receiving and those not receiving targeted agents, respectively (p = 0.01). Multivariate analysis showed that the use of targeted agents (hazard ratio 3.02, p = 0.003) was the only factor that predicted for improved survival. Two patients experienced post-GKS hemorrhage within the treated volume. Targeted agents appear to improve local control and overall survival in patients treated with GKS for metastastic RCC.