Gamma Knife Radiosurgery for Ten or More Brain Metastases
Gamma Knife Radiosurgery for Ten or More Brain Metastases
复制标题
DOI：
10.3340/jkns.2008.44.6.358
复制
发表时间：
2008-12-01
影响因子：
1.6
通讯作者：
Lee, Jung-Il
中科院分区：
文献类型：
--
作者：
Kim, Chang-Hyun;Im, Yong-Seok;Lee, Jung-Il
目的评价GKS治疗10个或10个以上脑转移瘤的疗效。方法2002年8月至2007年12月，对26例10个及以上脑转移灶患者（男13例，女13例）行GKS手术。平均年龄55岁（32 ~ 80岁）。所有患者的Karnofsky性能状态（KPS）评分均在70分或以上。按递归划分分析（RPA）分类，ⅰ类3例，ⅱ类23例。原发肿瘤部位为肺（21例）、乳腺（3例）和未知（2例）。平均每个患者的病变数为16.6（10-37）。平均累积容积为10.9 cc（1.0-42.2）。中位边际剂量为15 Gy（9-23）。采用Kaplan Meier法和单因素分析回顾性分析总生存率和影响生存率的预后因素。结果：GKS的总中位生存期为34周（8-199周）。79.5%的病变可以局部控制，至少14例（53.8%）患者在GKS后6个月可以控制所有病变。同期出现新病灶7例（26.9%）。最后一次随访时，18例患者死亡；6例（33.3%）为全身性原因，10例（55.6%）为神经系统原因，2例（11.1%）为未知原因。在单因素分析中，非小细胞肺癌的同步发病（p=0.007）、高KPS评分（>= 80,p=0.029）和原发疾病控制（p=0.020）是有利的预后因素。结论：在精心挑选的患者中，GKS可能是10个或更多脑转移的治疗选择。
Objective This study was performed to assess the efficacy of GKS in patients with ten or more brain metastases.Methods From Aug 2002 to Dec 2007, twenty-six patients (13 men and 13 women) with ten or more cerebral metastatic lesions underwent GKS. The mean age was 55 years (32-80). All patients had Karnofsky performance status (KPS) score of 70 or better. According to recursive partitioning analysis (RPA) classification, 3 patients belonged to class I and 23 to class II. The location of primary tumor was lung (21), breast (3) and unknown (2). The mean number of the lesions per patient was 16.6 (10-37). The mean cumulated volume was 10.9 cc (1.0-42.2). The median marginal dose was 15 Gy (9-23). Overall survival and the prognostic factors for the survival were retrospectively analyzed by using Kaplan Meier method and univariate analysis.Results : Overall median survival from GKS was 34 weeks (8-199). Local control was possible for 79.5% of the lesions and control of all the lesions was possible in at least 14 patients (53.8%) until 6 months after GKS. New lesions appeared in 7 (26.9%) patients during the same period. At the last follow-up, 18 patients died; 6 (33.3%) from systemic causes, 10 (55.6%) from neurological causes, and 2 (11.1%) from unknown causes. Synchronous onset in non-small cell lung cancer (p=0.007), high KPS score (>= 80, p=0.029), and controlled primary disease (p=0.020) were favorable prognostic factors in univariate analysis.Conclusion : In carefully selected patients, GKS may be a treatment option for ten or more brain metastases.