Stereotactic radiosurgery for patients with "radioresistant" brain metastases
Stereotactic radiosurgery for patients with "radioresistant" brain metastases
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DOI：
10.1227/01.neu.0000023713.44940.20
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发表时间：
2002-09-01
期刊：
影响因子：
4.8
通讯作者：
Foote, RL
中科院分区：
文献类型：
--
作者：
Brown, PD;Brown, CA;Foote, RL
目的：我们的目的是评估立体定向放射手术（SRS）治疗根据组织学检查确定为“放射耐药”的脑转移患者的疗效。方法：我们回顾了41例连续出现83例放射耐药原发性脑转移的患者的医疗记录，这些患者随后接受了SRS。所有患者均被随访至死亡或SRS后中位31个月。肿瘤组织学包括肾细胞癌（10例）、黑色素瘤（23例）、肉瘤（2例）。18例（44%）有单发转移，23例（56%）有多发转移。结果：SRS后中位总生存时间为14.2个月。在单因素分析的基础上，全系统疾病状态（P = 0.006）和放射治疗肿瘤组递归划分分析（RPA）分类（P = 0.005）与生存率相关。RPA I级患者的中位生存时间为23.5个月，RPA II或III级患者的中位生存时间为10.5个月。与黑色素瘤患者（9.7个月）相比，肾细胞癌患者（17.8个月）的中位生存期有改善的趋势（P = 0.12）。多因素分析显示，RPA分级（P = 0.038）和原发肿瘤的组织学诊断（P < 0.001）是总生存率的独立预测因素。在接受随访影像学检查的35例患者中，73例肿瘤中有9例（12%）局部复发。54%的患者发生远端脑衰竭（DBF）。根据单因素和多因素分析，全脑放疗（WBRT）改善了局部控制并降低了DBF。接受辅助WBRT和SRS的患者6个月精算局部控制率为100%，而未接受WBRT的患者为85% （P = 0.018）。接受辅助WBRT和SRS的患者6个月的精算DBF率为17%，而单独接受SRS的患者为64% （P = 0.0027）。结论：经过筛选的原发肿瘤放射耐药脑转移患者接受SRS治疗后的生存时间比既往对照组更长。RPA I级状态和原发性肾细胞癌预测更长的生存期。辅助WBRT可改善局部控制并降低DBF，但不影响总生存期。需要进一步的研究来确定哪些患者应该接受WBRT。
OBJECTIVE: Our aim was to evaluate the efficacy of stereotactic radiosurgery (SRS) fur the treatment of patients with brain metastases that have been determined to be "radioresistant" on the basis of histological examination.METHODS: We reviewed the medical records of 41 consecutive patients who presented with 83 brain metastases from radioresistant primaries and subsequently underwent SRS. All patients were followed until death or fur a median of 31 months after SRS. Tumor histologies included renal cell carcinoma (10 patients), melanoma (23 patients), and sarcoma (2 patients). Eighteen patients (44%) had a solitary metastasis, and 23 patients (56%) had multiple metastases.RESULTS: The median overall survival time was 14.2 months after SRS. On the basis of univariate analysis, systemic disease status (P = 0.006) and Radiation Therapy Oncology Group recursive partitioning analysis (RPA) class (P = 0.005) were associated with survival. The median survival time was 23.5 months for patients in RPA Class I status and 10.5 months for patients in RPA Class II or III status. There was a trend (P = 0.12) toward improved median survival for patients with renal cell carcinoma (17.8 mo) as compared with patients with melanoma (9.7 mo). Multivariate analysis showed RPA class (P = 0.038) and histological diagnosis of primary tumor (P < 0.001) to be independent predictors for overall survival. In the 35 patients who underwent follow-up imaging, 9 (12%) of 73 tumors recurred locally. In 54% of the patients, distant brain failure (DBF) developed. Whole brain radiotherapy (WBRT) improved local control and decreased DBF, according to the univariate and multivariate analyses. Patients who received adjuvant WBRT in addition to SRS had 6-month actuarial local control of 100% as compared with 85% among those who did not receive WBRT (P = 0.018). Patients who received adjuvant WBRT with SRS had a 6-month actuarial DBF rate of 17%, as compared with a rate of 64% among patients who had SRS alone (P = 0.0027).CONCLUSION: Well-selected patients with brain metastases from radioresistant primary tumors who undergo SRS survive longer than historical controls. RPA Class I status and primary renal cell carcinoma predict longer survival. Adjuvant WBRT improves local control and decreases DBF but does not affect overall survival. Further studies are needed to determine which patients should receive WBRT.