Tumor Histology Predicts Patterns of Failure and Survival in Patients With Brain Metastases From Lung Cancer Treated With Gamma Knife Radiosurgery

被引：55

作者：

Kuremsky, J. Griff ^{[1
]}

Urbanic, James J. ^{[1
]}

Petty, W. Jeff ^{[2
]}

Lovato, James F. ^{[4
]}

Bourland, J. Daniel ^{[1
]}

Tatter, Stephen B. ^{[3
]}

Ellis, Thomas L. ^{[1
,3
]}

McMullen, Kevin P. ^{[1
]}

Shaw, Edward G. ^{[1
]}

Chan, Michael D. ^{[1
]}

机构：

[1] Wake Forest Univ, Dept Radiat Oncol, Winston Salem, NC 27109 USA

[2] Wake Forest Univ, Dept Internal Med, Dept Hematol & Oncol, Winston Salem, NC 27109 USA

[3] Wake Forest Univ, Dept Neurosurg, Winston Salem, NC 27109 USA

[4] Wake Forest Univ, Dept Publ Hlth Sci, Winston Salem, NC 27109 USA

来源：

NEUROSURGERY | 2013年 / 73卷 / 04期

关键词：

Cranial metastases; Lung cancer; Stereotactic radiosurgery; PROPHYLACTIC CRANIAL IRRADIATION; STEREOTACTIC RADIOSURGERY; RADIOTHERAPY; RADIATION; THERAPY; CARCINOMA;

D O I：

10.1227/NEU.0000000000000072

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

BACKGROUND: We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). OBJECTIVE: To determine whether tumor histology predicts patient outcomes. METHODS: Between July 1, 2000, and December 31, 2010, 271 patients with brain metastases from primary lung cancer were treated with GKRS at our institution. Included in our study were 44 squamous cell carcinoma (SCC), 31 small cell carcinoma (SCLC), and 138 adenocarcinoma (ACA) patients; 47 patients with insufficient pathology to determine subtype were excluded. No non-small cell lung cancer (NSCLC) patients received whole-brain radiation therapy (WBRT) before their GKRS, and SCLC patients were allowed to have prophylactic cranial irradiation, but no previously known brain metastases. A median of 2 lesions were treated per patient with median marginal dose of 20 Gy. RESULTS: Median survival was 10.2 months for ACA, 5.9 months for SCLC, and 5.3 months for SCC patients (P = .008). The 1-year local control rates were 86%, 86%, and 54% for ACA, SCC, and SCLC, respectively (P = .027). The 1-year distant failure rates were 35%, 63%, and 65% for ACA, SCC, and SCLC, respectively (P =.057). The likelihood of dying of neurological death was 29%, 36%, and 55% for ACA, SCC, and SCLC, respectively (P =.027). The median time to WBRT was 11 months for SCC and 24 months for ACA patients (P =.04). Multivariate analysis confirmed SCLC histology as a significant predictor of worsened local control (hazard ratio [HR]: 6.46, P = .025) and distant failure (HR: 3.32, P = .0027). For NSCLC histologies, SCC predicted for earlier time to salvage WBRT (HR: 2.552, P = .01) and worsened overall survival (HR: 1.77, P < .0121). CONCLUSION: Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.

引用

页码：641 / 647

页数：7

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