Prognostic Factors for Survival in Patients Treated With Stereotactic Radiosurgery for Recurrent Brain Metastases After Prior Whole Brain Radiotherapy
Prognostic Factors for Survival in Patients Treated With Stereotactic Radiosurgery for Recurrent Brain Metastases After Prior Whole Brain Radiotherapy
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DOI：
10.1016/j.ijrobp.2011.06.1987
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发表时间：
2012-05-01
影响因子：
7
通讯作者：
McDermott, Michael W.
中科院分区：
文献类型：
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作者：
Caballero, Jorge A.;Sneed, Penny K.;McDermott, Michael W.
目的：为了评估预后因素的生存立体定向放射外科手术（SRS）后，新的，进行性的，或复发性脑转移瘤（BM）前全脑放疗（WBRT）后，方法和材料：1991年至2007年之间治疗的患者与伽玛刀SRS BM前WBRT后进行了回顾性分析。使用单变量和逐步多变量分析和递归分割分析，对潜在的预后因素进行了总体分析和原发部位分析，包括年龄、Karnofsky体力状态（KPS）、原发肿瘤控制、颅外转移、治疗的BM数量、总SRS靶体积和WBRT至SRS的间隔。共分析了310例患者，包括90例乳腺癌、113例非小细胞肺癌、31例小细胞肺癌、42例黑色素瘤和34例其他患者。中位年龄为56岁，KPS 80，接受治疗的BM数量为3例，从WBRT到SRS的间隔为8.1个月; 76%的原发肿瘤得到控制，60%有颅外转移。总体中位生存期为8.4个月，单次与多次BM治疗的中位生存期分别为12.0和7.9个月（p = 0.001）。排除单BM患者后，BM数量与生存率之间无相关性。多变量分析，有利的预后因素包括年龄60岁，控制原发性非小细胞肺癌患者;和较小的总目标体积在黑色素瘤patients.Conclusions：在与补救SRS治疗BM患者之前WBRT后，预后因素出现不同的主要网站。尽管单个BM患者的生存时间显著更长，但多个BM患者的中位生存时间（7.9个月）似乎足够长，值得进行挽救性SRS，并且未发现证据支持使用适用于挽救性SRS的BM数量截止值。(C)2012 Elsevier Inc.
Purpose: To evaluate prognostic factors for survival after stereotactic radiosurgery (SRS) for new, progressive, or recurrent brain metastases (BM) after prior whole brain radiotherapy (WBRT).Methods and Materials: Patients treated between 1991 and 2007 with Gamma Knife SRS for BM after prior WBRT were retrospectively reviewed. Potential prognostic factors were analyzed overall and by primary site using univariate and stepwise multivariate analyses and recursive partitioning analysis, including age, Karnofsky performance status (KPS), primary tumor control, extracranial metastases, number of BM treated, total SRS target volume, and interval from WBRT to SRS.Results: A total of 310 patients were analyzed, including 90 breast, 113 non-small-cell lung, 31 small-cell lung, 42 melanoma, and 34 miscellaneous patients. The median age was 56, KPS 80, number of BM treated 3, and interval from WBRT to SRS 8.1 months; 76% had controlled primary tumor and 60% had extracranial metastases. The median survival was 8.4 months overall and 12.0 vs. 7.9 months for single vs. multiple BM treated (p = 0.001). There was no relationship between number of BM and survival after excluding single-BM patients. On multivariate analysis, favorable prognostic factors included age 60, and controlled primary in non-small-cell lung cancer patients; and smaller total target volume in melanoma patients.Conclusions: Among patients treated with salvage SRS for BM after prior WBRT, prognostic factors appeared to vary by primary site. Although survival time was significantly longer for patients with a single BM, the median survival time of 7.9 months for patients with multiple BM seems sufficiently long for salvage SRS to appear to be worthwhile, and no evidence was found to support the use of a cutoff for number of BM appropriate for salvage SRS. (C) 2012 Elsevier Inc.