A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis
A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis
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DOI：
10.1016/s0360-3016(96)85008-5
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发表时间：
1996-04-01
影响因子：
7
通讯作者：
Mehta, MP
中科院分区：
文献类型：
--
作者：
Auchter, RM;Lamond, JP;Mehta, MP
目的：最近的随机试验选择了单一脑转移瘤患者，比较了切除后全脑放疗（WBRT）与单纯WBRT，结果显示手术和WBRT具有统计学显著的生存优势。进行了一项多机构的回顾性研究，确定了可比较的患者谁是治疗与立体定向放射外科（RS）和WBRT.Methods和材料：RS数据库的四个机构进行了审查，以确定谁符合以下标准的患者：单脑转移，没有以前的颅脑手术或WBRT，年龄> 18岁，手术切除病变，RS时Karnofsky体能状态（KPS）≥ 70;非放射敏感性组织学。122例患者仅仅确定谁符合这些标准。患者仅按以下分类：（a）原发状态，（B）非CNS转移状态，（c）年龄，（d）基线KPS（70-100），（c）组织学，（f）从原发诊断到检测到脑转移的时间，（g）性别，和（h）肿瘤体积。采用基于直线加速器的技术进行RS（外周剂量范围为10-27戈伊，中位数为17戈伊）。除了5名拒绝接受WBRT的患者外，所有患者均接受了WBRT（剂量范围为25-40戈伊，中位数为37.5戈伊）。结果：所有患者的中位随访时间为123周。总体局部控制率（定义为RS体积无进展）为86%。在27例患者（22%）中观察到RS体积外的颅内复发。从RS日期起的精算中位生存期为56周，1年和2年精算生存率分别为53%和30%。功能独立的中位持续时间（持续KPS大于或等于70）为44周。77例死亡中有19例归因于CNS进展（占所有死亡的25%）。多因素分析显示以下因素是统计学上显著的生存预测因素：基线KPS（p <0.0001）和无其他部位转移（p = 0.008.Conclusion：RS联合WBRT治疗单发脑转移瘤可获得实质性的功能生存，尤其是在体能状态良好且无颅外转移的患者中。这些结果与最近的切除术和WBRT的随机试验相当。RS在费用、住院、发病率和更广泛的适用性方面优于手术，这强烈表明需要进行一项随机试验来比较RS与手术。
Purpose: Recent randomized trials of selected patients with single brain metastasis comparing resection followed by whole-brain radiotherapy (WBRT) to WBRT alone have shown a statistically significant survival advantage for surgery and WBRT. A multiinstitutional retrospective study was performed, which identified comparable patients who were treated with stereotactic radiosurgery (RS) and WBRT.Methods and Materials: The RS databases of four institutions were reviewed to identify patients who met the following criteria: single-brain metastasis; no prior cranial surgery or WBRT; age > 18 years; surgically resectable lesion; Karnofsky Performance Status (KPS) greater than or equal to 70 at time of RS; nonradiosensitive histology. One hundred twenty-two patients mere identified who met these criteria. Patients mere categorized by: (a) status of the primary, (b) status of non-CNS metastasis, (c) age, (d) baseline KPS (from 70-100), (c) histology, (f) time from diagnosis of primary to the detection of the brain metastasis, (g) gender, and (h) tumor volume. RS was performed with a linear accelerator based technique (peripheral dose range was 10-27 Gy, median was 17 Gy). WBRT was performed in all but five patients who refused WBRT (dose range was 25-40 Gy, median was 37.5 Gy). Results: The median follow-up for all patients was 123 weeks. The overall local control rate (defined as lack of progression in the RS volume) was 86%. Intracranial recurrence outside of the RS volume was seen in 27 patients (22%). The actuarial median survival from date of RS is 56 weeks, and the 1-year and 2-year actuarial survival rates are 53 and 30%. The median duration of functional independence (sustained KPS greater than or equal to 70) is 44 weeks. Nineteen of 77 deaths were attributed to CNS progression (25% of all deaths). Multivariate analysis revealed the following factors to be statistically significant predictors of survival: baseline KPS (p < .0001) and absence of other sites of metastasis (p = 0.008).Conclusion: The RS in conjunction with WBRT for single brain metastasis can produce substantial functional survival, especially in patients with good performance status and without extracranial metastasis. These results are comparable to recent randomized trials of resection and WBRT. The advantages of RS over surgery in terms of cost, hospitalization, morbidity, and wider applicability strongly suggest that a randomized trial to compare RS with surgery is warranted.