A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases
A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases
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DOI：
10.1016/s0360-3016(02)04379-1
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发表时间：
2003-04-01
影响因子：
7
通讯作者：
O'Fallon, JR
中科院分区：
文献类型：
--
作者：
O'Neill, BP;Iturria, NJ;O'Fallon, JR
目的：探讨神经外科(NS)和立体定向放射外科(RS)是否能更好地控制局部肿瘤，提高患者的生存率。方法和材料：对1991年至1999年在梅奥诊所罗切斯特新诊断的所有孤立性脑转移瘤(SBM)患者进行回顾性分析。结果：74例NS患者和23例RS患者在基线特征(年龄、性别、全身疾病类型、全身疾病状态、SBM出现时的体征/症状)或接受全脑放射治疗的患者百分比方面均无显著差异。存活患者的中位随访期为20个月(范围0-106个月)。两组患者生存率差异无统计学意义(P=0.15)，RS组1年生存率为56%，NS组为62%。多变量COX回归分析发现，影响生存的一个重要预后因素是绩效评分为0.020或1。对于孤立性脑转移瘤，NS组和RS组的局部肿瘤控制有显著差异(p=0.020)；与NS组的19例(58%)相比，RS组无一例局部复发。结论：这项研究的数据似乎支持对这两种技术进行III期研究的必要性。(C)2003年爱思唯尔科学公司。
Purpose: To determine whether neurosurgery (NS) or stereotactic radiosurgery (RS) provided better local tumor control and enhanced patient survival.Methods and Materials: Retrospective review of all solitary brain metastases (SBM) patients newly diagnosed at Mayo Clinic Rochester between 1991 and 1999. Eligible patients satisfied tumor size and SBM site criteria to qualify for both NS and RS.Results: There were no significant differences between 74 NS and 23 RS patients in terms of baseline characteristics (age, gender, systemic disease type, systemic disease status, signs/symptoms at SBM presentation) or percent of patients who received whole brain radiotherapy. Median follow-up for alive patients was 20 months (range 0-106 months). There was no significant difference in patient survival (p = 0.15); the 1-year survival rate was 56% for the RS patients and 62% for the NS patients. Multivariate Cox regression analysis found that a significant prognostic factor for survival was a performance score of 0 or 1. There was a significant (p = 0.020) difference in local tumor control between NS and RS for solitary brain metastasis; none of the RS group had local recurrence compared to 19 (58%) of the NS group.Conclusion: The need for a Phase III study comparing these two techniques appears to be supported by the data from this study. (C) 2003 Elsevier Science Inc.