Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers.
Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers.
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DOI：
10.1002/cncr.28307
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发表时间：
2013-11-01
期刊：
影响因子：
6.2
通讯作者：
Ewend MG
中科院分区：
文献类型：
--
作者：
Brem S;Meyers CA;Palmer G;Booth-Jones M;Jain S;Ewend MG
神经外科手术切除和全脑放射治疗(WBRT)是接受治疗的单一和少转移癌到脑。为了避免与WBRT相关的神经认知功能(NCF)的下降，作者进行了一项前瞻性的多中心2期研究，以确定手术和卡莫司汀晶片(CW)在推迟WBRT的同时是否可以保留NCF并实现局部控制(LC)。对59例因单发(83%)或显性(少转移，2~3个)转移而行CW的切除患者和未经切除加CW治疗的微小结节行立体定向放射外科治疗(SRS)。NCF的保存被定义为在记忆、执行功能和精细运动技能3个领域与基线的≤1标准差的改善或下降，每隔2个月进行一次评估。在1年的随访中，执行功能和记忆力都有了显著的改善。在每个2个月的间隔中，大多数患者的NCF在所有3个领域都得到了保留或改善。仅1例患者NCF值下降。化疗药片耐受性良好，严重不良反应是可逆的。随访1年，局部复发率为28%。脑转移瘤患者在接受切除加CW治疗后，其认知轨迹有改善，尤其是记忆和执行功能。LC的发生率(78%)与WBRT的历史手术率相当，但优于单独WBRT的报道。对于因症状性或大体积转移或组织诊断而行手术切除的患者，可考虑附加CW。
Neurosurgical resection and whole-brain radiation therapy (WBRT) are accepted treatments for single and oligometastatic cancer to the brain. To avoid the decline in neurocognitive function (NCF) linked to WBRT, the authors conducted a prospective, multicenter, phase 2 study to determine whether surgery and carmustine wafers (CW), while deferring WBRT, could preserve NCF and achieve local control (LC). NCF and LC were measured in 59 patients who underwent resection and received CW for a single (83%) or dominant (oligometastatic, 2 to 3 lesions) metastasis and received stereotactic radiosurgery (SRS) for tiny nodules not treated with resection plus CW. Preservation of NCF was defined as an improvement or a decline ≤1 standard deviation from baseline in 3 domains: memory, executive function, and fine motor skills, evaluated at 2-month intervals. Significant improvements in executive function and memory occurred throughout the 1-year follow-up. Preservation or improvement of NCF occurred in all 3 domains for the majority of patients at each of the 2-month intervals. NCF declined in only 1 patient. The chemowafers were well tolerated, and serious adverse events were reversible. There was local recurrence in 28% of the patients at 1-year follow-up. Patients with brain metastases had improvements in their cognitive trajectory, especially memory and executive function, after treatment with resection plus CW. The rate of LC (78%) was comparable to historic rates of surgery with WBRT and superior to reports of WBRT alone. For patients who undergo resection for symptomatic or large-volume metastasis or for tissue diagnosis, the addition of CW can be considered as an option.
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影响因子：
45.3
作者：
Meyers, CA;Smith, JA;Renschler, MF
通讯作者：
Renschler, MF
影响因子：
120.7
作者：
Aoyama, Hidefumi;Shirato, Hiroki;Kobashi, Gen
通讯作者：
Kobashi, Gen
影响因子：
45.3
作者：
Deprez, Sabine;Amant, Frederic;Sunaert, Stefan
通讯作者：
Sunaert, Stefan
DOI：
10.1038/nrclinonc.2011.58
发表时间：
2011-06
期刊：
Nature reviews. Clinical oncology
影响因子：
--
作者：
通讯作者：
--
影响因子：
45.3
作者：
Kocher, Martin;Soffietti, Riccardo;Mueller, Rolf-Peter
通讯作者：
Mueller, Rolf-Peter