Brain Metastases Treated with Radio surgery Alone:An Alternative to Whole Brain Radiotherapy?

摘要

OBJECTIVE:Whole brain radiotherapy(WBRT)provides benefit for patients with b rain metastases but may result in neurological toxicity for patien ts with extended survival times.Ste reotactic radiosurgery in combination with WBRT has become an important approach,but the value of WBRT has been questioned.As an alternative to WBRT,we managed patients with stereotactic radiosurgery alone,evaluated pati ents’outcomes,and assessed prognostic factors for survival and tumor c ontrol.METHODS:One hundred seventy-two patients with b rain metastases were managed with ra diosurgery alone.One hundred twent y-one patients were evaluable with follow-up imaging after radiosurgery.The median patien t age was 60.5years(age range,16-86yr).The mean marginal tumor dose and volume were 18.5Gy (range,11-22Gy )and 4.4ml (range,0.1-24.9ml ).Eighty percent of patients had soli tary tumors.RESULTS:The overall median survival time was8months.The median survival time in patients with no evidence of primary tumor disease or stable disease was 13and 11months.The local tumor contr ol rate was 87%.At 2years,the rate of local control,remote brain control,and total intr acranial control were 75%,41%,and 27%,respectively.In multivariate a nalysis,advanced primary tumor status(P=0.0003),older age(P=0.008),lower Karnofsky Performance Scale score(P=0.01),and malignant melanoma (P=0.005)were significant for poorer surviva l.The median survival time was 28mon ths for patients younger than 60years of age,with Karnofsky Performance Scale score o f at least 90,and whose primary tumor status showed either no evidence of disease or stable disease.Tumor volume (P=0.02)alone was significant for local tumo r control,whereas no factor affecte d remote or intracranial tumor contr ol.Eleven patients developed complica tions,six of which were persistent.Nineteen(16.5%)of 116patients in whom the cause of death was obtained died as a result of cause s related to brain metastasis.CONCLUSION:Brain metastases were controlled we ll with radiosurgery alone as initial thera py.We advocate that WBRT should not be part of the initial treatment proto col for selected patients with one or two tumors with good control of their primary cancer,better Karnofsky Performance Scale score,and you nger age,all of which are predictors of longer