Score Index for Stereotactic Radiosurgery of Brain Metastases
Journal of Radiosurgery - 1998
Tóm tắt
A reliable prognostic score for cancer patients with brain metastases submitting to stereotactic radiosurgery (SR) was established. Between July 1993 and December 1995, 34 cancer patients (36 treatments and 69 lesions) with brain metastases were treated with SR at the Hospital Israelita Albert Einstein of São Paulo, Brazil. The exclusion criteria were: more than 5 lesions, any lesion larger than 30 cm3, Karnofsky performance status (KS) less than 50, clinical evidence urging neurosurgical intervention or very poor overall prognosis due to fast progressive systemic disease (SD). The score index for stereotactic radiosurgery of brain metastases (SIR) was obtained by summing up the points of the five variables: age, KS, SD, size (LS), and number of lesions (NL). The Kaplan–Meier method together with log rank was used to estimate and test correlation between survival and all prognostic factors. Applying the SIR definition to our patients' survival data through the Kaplan–Meier method we found out that the expected median survival for patients with 6 points or less was 3.67 months and for those with more than 6 points it was 16.16 months (p = 0.0005). Age, SD, KS, and NL were also significantly correlated with the prognosis (p-values at log-rank test of 0.0020, 0.0071, 0.0181, and 0.0454, respectively). Analyzing our data we concluded that the SIR is a reliable prognostic score for cancer patients with brain metastases submitting to SR. This index should be tested for larger series.
Từ khóa
Tài liệu tham khảo
Leksell L: The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316–319, 1951
Alexander III E, Moriaty TM, Davis RB, Wen PY, Fine HA, Black PM, Kooy HM, Loeffler JS: Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst 87:34–40, 1995
Buckner J: Surgery, radiation therapy, and chemotherapy for metastatic tumors to the brain. Curr Opin Oncol 4(3):518–524, 1992
Lutz W, Winston KR, Maleki N: A system for stereotactic radiosurgery using linear accelerator. Int J Radiat Oncol Biol Phys 14: 373–381, 1988
Winston KR, Lutz W: Linear accelerator as a surgical tool for stereotactic radiosurgery. Neurosurgery 22:454–464, 1988
Kooy HM, Nedzi LA, Loeffler JS, Alexander III E, Cheng CW, Mannnarino EG, Holupka EJ, Siddon RL: Treatment planning for stereotactic radiosurgery of intra-cranial lesions. Int J Radiat Oncol Biol Phys 21:683–693, 1991
Metha MP, Rozental JM, Levin AB, Mackie TR, Kubsad SS, Gehring MA, Kinsela TJ: Defining the role of radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 24:619–625, 1992
Patchell RA, Tibbs PA, Walsh JH, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, MacDonald JS, Young BA: A randomized trial of surgery in the treatment of single metastases to the brain. N Eng J Med 322:494–500, 1990
Hazra T, Mullins GN, Lott S: Management of cerebral metastases from bronchogenic carcinoma. Johns Hopkins Med J 130:377–383, 1972
Maskesbery WR, Brooks WH, Gupta GD: Treatment for patients with cerebral metastases. Arch Neurol 35:754–756, 1978
Zimm S, Wampler GL, Stalblein D, Hazra T, Young HF: Intracranial metastases in solid tumor patients: Natural history and results of treatment. Cancer 48:394–394, 1981
Cairncross JG, Kim JH, Posner JB: Radiation therapy for brain metastases. Ann Neurol 7:529–541, 1980
Coia LR, Aaronson N, Linggoog R, Loeffler JS, Priestman TJ: A report on the Consensus Workshop Panel of brain metastases. Int J Radiat Oncol Biol Phys 23:223–227, 1992
Coia LR: The role of radiation therapy in the treatment of brain metastases. Int J Radiat Oncol Biol Phys 23:229–238, 1992
Galicich JH, Sandaresan N: Metastatic brain tumors. In Neurosurgery. RH Wilkins, SS Regachary (eds). New York, McGraw-Hill, 1985, pp 597–610
Wright DC, Delaney TF, Buckner JC: Treatment of metastatic cancer to the brain. In Cancer: Principles and Practice of Oncology, 4th ed. VT DeVita Jr., S Hellman, SA Rosenberg (eds). Philadelphia, Lippincott, 1993, pp 2170–2188
Davey P, O'Brien P: Disposition of cerebral metastases from malignant melanoma: Implications for radiosurgery. Neurosurgery 28:8–15, 1991
Smalley SR, Schray MF, Lans ER Jr, O'Fallon JR: Adjuvant radiation therapy after surgical resection of solitary brain metastases: Association of patterns of failure and survival. Int J Radiat Oncol Biol Phys 13:1611–1616, 1987
Faria SL, Souhami L, Caron JL, Behary JP, Clark B, Villemure JG, Olivier A, Adamson N, Podgorsak EB: Radiocirurgia estereotática no treatmento paliativo das metástases cerebrals. Radiol Bras 28:239–245, 1995
Fuller BG, Adler J, Cox RS, Kaplan ID: Stereotaxic radiosurgery for brain metastases: The importance of whole brain Irradiation. Int J Radiat Oncol Biol Phys 23:413–418, 1992
Loeffler JS, Kooy HM, Wen PY, Fine HÁ, Cheng CH, Monnarino EG, Tsai JS, Alexander III E: The treatment of recurrent brain metastases with stereotactic radiosurgery. J Clin Oncol 8:576–582, 1990
Somaza S, Kondziolka D, Lunsford LD, Kirkwood JM, Flickinger JC: Stereotactic radiosurgery for cerebral metastatic melanoma. J Neurosurg 79:661–666, 1993
Sturm V, Kober B, Hover KH, Schlegel W, Boesecke R, Pastyr O, Kunze S, Lorenz WJ: Stereotactic percutaneous single dose irradiation of brain metastases with linear accelerator. Int J Radiat Oncol Biol Phys 13:279–282, 1987
Valentino V, Mirri MA, Schinaia G, Dalle-Ore G: Linear accelerator and Greitz Bergstrom's fixation system in radiosurgery of single cerebral metastases. A report of 86 cases. Acta Neurochir Wien 121:140–145, 1993
Hiyama H, Harai K, Hayashi S, Nakamura S, Izawa M, Takakura K: Stereotactic radiosurgery for brain metastases: The efficacy of Gamma Knife in large tumors. In Stereotactic and Functional Radiosurgery. PK Pillay, PL Gildenberg, PO Franklin (eds). Singapore, S Karger Publishers, 1995, p 73
Kihlstrom L, Karlsson B, Lindquist C: Gamma Knife surgery for cerebral metastases. Implications for survival based on 16 years experience. Stereotact Func Neurosurg 61(1):45–50, 1993
Buatti JM, Friedman WA, Bova FJ, Mendenhall WM: Treatment selection factors for stereotactic radiosurgery of intracranial metastases. Int J Radiat Oncol Biol Phys 32:1161–1166, 1995
Spetzer RT, Martin NA: A proposed grading system for arteriovenous malformation. J Neurosurg 65:476–483, 1986
Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer. In Evaluation of Chemotherapeutic Agents. CM MacLeod (ed). New York, Columbia University Press, 1949, pp 191–205
Lee E: Statistical Methods for Survival Data Analysis. Delmont, California, Life-Time Learning Publishing, 1980
Lunsford LD, Alexander III E, Loeffler JS: General introduction: History of radiosurgery. In Stereotactic Radiosurgery. E Alexander III, LD Lunsford, JS Loeffler (eds). New York, McGraw-Hill, 1993, pp 1–4
Posner JB: Management of central nervous system metastases. Semin Oncol 4:81–91, 1977
Weissman DE: Glucocorticoid treatment for brain metastases and epidural spinal cord compression: A review. J Clin Oncol 6:543–550, 1988
Bindal RK, Sawaya R, Leavens ME, Hess KR, Taylor SH: Reoperation for recurrent metastatic brain tumors. J Neurosurg 83: 600–604, 1995
Chao JH, Phillips R, Nickson JJ: Roentgen-ray therapy of cerebral metastases. Cancer 7:682–689, 1954
Borgelt B, Gelber R, Kramer S, Brady LW, Chang CH, Davis LW, Perez CA, Hendrickson FR: The palliation of brain metastases. Final result of the first two studies by the Radiation Oncology Group. Int J Radiat Oncol Biol Phys 6:1–8, 1980
Curran W, Scott C, Nelson D, Suse W: Results from the RTOG Phase I/II twice daily RT dose scalation trials for malignant glioma (83–02) and brain metastases (85–28). Presented at, the Ninth International Conference on Brain Tumor Research and Therapy, Pacific Grove, California, October 15–18, 1991
Delattre J, Krol G, Thaler H, Posner J: Distribution of brain metastases. Arch Neurol 45:741–744, 1988