Linear accelerator-based stereotaxic radiosurgery for brain metastases: The influence of number of lesions on survival

被引:141
作者
Joseph, J
Adler, JR
Cox, RS
Hancock, SL
机构
[1] STANFORD UNIV,CTR MED,DEPT RADIAT ONCOL,STANFORD,CA 94305
[2] STANFORD UNIV,CTR MED,DEPT NEUROSURG,STANFORD,CA 94305
关键词
D O I
10.1200/JCO.1996.14.4.1085
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To evaluate the influence of the number of brain metastases on survival after stereotaxic radiosurgery and factors that affect the risk of delayed radiation necrosis after treatment. Materials and Methods: Between March 1989 and December 1993, 120 consecutive patients underwent linear accelerator-based stereotaxic radiosurgery for brain metastases identified by computed tomography (CT) or magnetic resonance image (MRI) scans, The influence of various clinical factors on outcome was assessed using Kaplan-Meier plots of survival from the date of radiosurgery, and univariate and multivariate analyses. Results: The median survival time was 32 weeks, Progressive brain metastases, both local and regional, caused 25 of 104 deaths, Patients with two metastases (n = 30) or a solitary metastasis (n = 70) had equivalent actuarial survival times (P = 0.7; median, 37 weeks; maximum, 211+ weeks), Patients treated to three or more metastases (n = 20) had significantly shorter survival times (P < .002; median, 14 weeks; maximum, 63 weeks). Prognostic factors associated with prolonged survival included a pretreatment Karnofsky performance status greater than or equal to 70% and fewer than three metastases. Delayed radiation necrosis at the treated site developed in 20 patients and correlated with prior or concurrent delivery of whole-brain irradiation and the logarithm of the tumor volume. Conclusion: Survival duration is equivalent for patients with one or two brain metastases and is similar to that reported for patients with a solitary metastasis managed by surgical resection and whole-brain irradiation. Survival after radiosurgery for three or more metastases was similar to that reported for whole-brain irradiation. (C) 1996 by American Society of Clinical Oncology.
引用
收藏
页码:1085 / 1092
页数:8
相关论文
共 17 条
  • [1] STEREOTAXIC RADIOSURGICAL TREATMENT OF BRAIN METASTASES
    ADLER, JR
    COX, RS
    KAPLAN, I
    MARTIN, DP
    [J]. JOURNAL OF NEUROSURGERY, 1992, 76 (03) : 444 - 449
  • [2] STEREOTAXIC RADIOSURGERY FOR THE DEFINITIVE, NONINVASIVE TREATMENT OF BRAIN METASTASES
    ALEXANDER, E
    MORIARTY, TM
    DAVIS, RB
    WEN, PY
    FINE, HA
    BLACK, PM
    KOOY, HM
    LOEFFLER, JS
    [J]. JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 1995, 87 (01): : 34 - 40
  • [3] SURGICAL-TREATMENT OF MULTIPLE BRAIN METASTASES
    BINDAL, RK
    SAWAYA, R
    LEAVENS, ME
    LEE, JJ
    [J]. JOURNAL OF NEUROSURGERY, 1993, 79 (02) : 210 - 216
  • [4] BREGA K, 1990, CANCER, V66, P2105, DOI 10.1002/1097-0142(19901115)66:10<2105::AID-CNCR2820661011>3.0.CO
  • [5] 2-I
  • [6] Byrne T N, 1983, J Neurooncol, V1, P313, DOI 10.1007/BF00165714
  • [7] COX DR, 1972, J R STAT SOC B, V34, P187
  • [8] Cox DR, 1970, ANAL BINARY DATA, P76
  • [9] IDENTIFICATION OF AN OPTIMAL SUBGROUP FOR TREATMENT EVALUATION OF PATIENTS WITH BRAIN METASTASES USING RTOG STUDY-7916
    DIENERWEST, M
    DOBBINS, TW
    PHILLIPS, TL
    NELSON, DF
    [J]. INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1989, 16 (03): : 669 - 673
  • [10] A MULTIINSTITUTIONAL EXPERIENCE WITH STEREOTAXIC RADIOSURGERY FOR SOLITARY BRAIN METASTASIS
    FLICKINGER, JC
    KONDZIOLKA, D
    LUNSFORD, LD
    COFFEY, RJ
    GOODMAN, ML
    SHAW, EG
    HUDGINS, WR
    WEINER, R
    HARSH, GR
    SNEED, PK
    LARSON, DA
    [J]. INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1994, 28 (04): : 797 - 802