Adjuvant Gamma Knife radiosurgery following surgical resection of brain metastases: a 9-year retrospective cohort study

被引:47
作者
Hwang, Steven W. [1 ]
Abozed, Mohab M. [1 ]
Hale, Andrew [1 ]
Eisenberg, Rebecca L. [2 ]
Dvorak, Tomas [3 ]
Yao, Kevin [1 ]
Pfannl, Rolf [4 ]
Mignano, John [3 ]
Zhu, Jay-Jiguang [2 ,5 ]
Price, Lori Lyn [6 ]
Strauss, Gary M. [2 ]
Wu, Julian K. [1 ]
机构
[1] Tufts Med Ctr, Dept Neurosurg, Boston, MA 02111 USA
[2] Tufts Med Ctr, Dept Med, Div Hematol Oncol, Boston, MA 02111 USA
[3] Tufts Med Ctr, Dept Radiat Oncol, Boston, MA 02111 USA
[4] Tufts Med Ctr, Dept Anat Pathol, Boston, MA 02111 USA
[5] Tufts Med Ctr, Dept Neurol, Boston, MA 02111 USA
[6] Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA 02111 USA
关键词
Gamma Knife; Radiosurgery; Cerebral metastasis; Brain metastasis; Brain neoplasms; Craniotomy; RADIATION-THERAPY; STEREOTACTIC RADIOSURGERY; CEREBRAL METASTASES; RADIOTHERAPY; MANAGEMENT; TUMORS; TRIAL;
D O I
10.1007/s11060-009-0051-x
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Given the potential morbidity of whole brain radiation therapy (WBRT), there has been an increasing trend to defer WBRT and deliver Gamma Knife stereotactic radiosurgery (GKS) to cerebral metastatic lesions. We analyzed our experience delivering GKS to the tumor cavity following surgical resection of brain metastases and compared our results to patients receiving WBRT after surgical resection of a metastatic lesion. We performed a retrospective review of patients undergoing surgical resection of at least one brain metastasis between December 1999 and December 2008. Both univariate and multivariate Cox proportional hazards regression were utilized to analyze the influence of various prognostic factors on survival. Twenty-five patients had a metastatic lesion resected followed by adjuvant GKS to the resection cavity while another 18 had surgical resection followed by WBRT. Aside from a disparity in gender distribution (72% of GKS patients were female while women only constituted 28% of the WBRT group), no significant differences existed between groups. The median survival for patients receiving GKS was 15.00 months as compared to 6.81 months among those receiving WBRT (P = 0.08). Univariate Cox regression analysis identified the number of metastases (HR 1.65, 95% CI 1.07-2.54, P = 0.02) and regional recurrence (RR 5.23, 95% CI 1.78-15.38, P = 0.003) as poor prognostic factors. Multivariate regression analysis showed that regional recurrence (HR 5.17, 95% CI 1.69-15.78, P = 0.004) was again strongly associated with worse survival. Although limited by the retrospective nature of our study and lack of some clinical measures, patients undergoing GKS to the resection cavity had a trend towards longer median survival.
引用
收藏
页码:77 / 82
页数:6
相关论文
共 22 条
[1]   Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial [J].
Andrews, DW ;
Scott, CB ;
Sperduto, PW ;
Flanders, AE ;
Gaspar, LE ;
Schell, MC ;
Werner-Wasik, M ;
Demas, W ;
Ryu, J ;
Bahary, JP ;
Souhami, L ;
Rotman, M ;
Mehta, MP ;
Curran, WJ .
LANCET, 2004, 363 (9422) :1665-1672
[2]   Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases - A randomized controlled trial [J].
Aoyama, Hidefumi ;
Shirato, Hiroki ;
Tago, Masao ;
Nakagawa, Keiichi ;
Toyoda, Tatsuya ;
Hatano, Kazuo ;
Kenjyo, Masahiro ;
Oya, Natsuo ;
Hirota, Saeko ;
Shioura, Hiroki ;
Kunieda, Etsuo ;
Inomata, Taisuke ;
Hayakawa, Kazushige ;
Katoh, Norio ;
Kobashi, Gen .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2006, 295 (21) :2483-2491
[3]  
ASAI A, 1989, CANCER-AM CANCER SOC, V63, P1962, DOI 10.1002/1097-0142(19890515)63:10<1962::AID-CNCR2820631016>3.0.CO
[4]  
2-V
[5]   PALLIATION OF BRAIN METASTASES - FINAL RESULTS OF THE 1ST 2 STUDIES BY THE RADIATION-THERAPY-ONCOLOGY-GROUP [J].
BORGELT, B ;
GELBER, R ;
KRAMER, S ;
BRADY, LW ;
CHANG, CH ;
DAVIS, LW ;
PEREZ, CA ;
HENDRICKSON, FR .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1980, 6 (01) :1-9
[6]   Management of brain metastases [J].
Bradley, KA ;
Mehta, MP .
SEMINARS IN ONCOLOGY, 2004, 31 (05) :693-701
[7]   RADIATION-THERAPY FOR BRAIN METASTASES [J].
CAIRNCROSS, JG ;
KIM, JH ;
POSNER, JB .
ANNALS OF NEUROLOGY, 1980, 7 (06) :529-541
[8]   Application of recursive partitioning analysis and evaluation of the use of whole brain radiation among patients treated with stereotactic radiosurgery for newly diagnosed brain metastases [J].
Chidel, MA ;
Suh, JH ;
Reddy, CA ;
Chao, ST ;
Lundbeck, MF ;
Barnett, GH .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2000, 47 (04) :993-999
[9]   RADIATION-INDUCED DEMENTIA IN PATIENTS CURED OF BRAIN METASTASES [J].
DEANGELIS, LM ;
DELATTRE, JY ;
POSNER, JB .
NEUROLOGY, 1989, 39 (06) :789-796
[10]   IDENTIFICATION OF AN OPTIMAL SUBGROUP FOR TREATMENT EVALUATION OF PATIENTS WITH BRAIN METASTASES USING RTOG STUDY-7916 [J].
DIENERWEST, M ;
DOBBINS, TW ;
PHILLIPS, TL ;
NELSON, DF .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1989, 16 (03) :669-673