影响脑转移性黑色素瘤治疗后预后的因素

Christopher J. Carrubba BS, Todd W. Vitaz MD
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引用次数: 8

摘要

背景:由于脑转移性黑色素瘤的治疗存在固有的困难,包括疾病进展率高和局部治疗失败,我们试图确定影响这些患者预后的预后因素,并基于手术切除或SRS的初步治疗回顾了患者的预后。方法回顾性分析了2002年7月至2007年4月间接受转移性黑色素瘤治疗的37例患者。获得的信息包括全身性疾病、术前症状、肿瘤大小和位置、疾病复发、一次和二次治疗以及生存时间。结果截至2008年3月,2例患者存活。最初接受手术切除治疗的患者中位生存时间为9.7个月,而最初接受SRS治疗的患者中位生存时间为7.9个月。单独脑转移、术前无出血和肺转移是两组患者提高生存率的预后因素。4例接受SRS初步治疗的患者因放射坏死(3例)或局部复发(1例)需要后续手术干预。4例病灶均大于1.5 cm。对于手术患者,放疗或放疗的计划术后治疗将生存时间增加到12.3个月对7.3个月。结论预后阳性因素包括孤立性脑病变、术前无出血、无肺部疾病的患者可以进行积极的手术干预,然后辅以放射外科或常规放射治疗。其他患者应考虑更保守的放疗或其他姑息性治疗。
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Factors affecting the outcome after treatment for metastatic melanoma to the brain

Background

Because of the difficulties inherent to the treatment of metastatic melanoma to the brain including high rates of disease progression and local treatment failure, we attempted to determine the prognostic factors that impacted the outcome of these patients, and reviewed patient outcome based on primary treatment with either surgical resection or SRS.

Methods

A retrospective review identified 37 patients treated for metastatic melanoma between July 2002 and April 2007. Information was obtained documenting systemic disease, preoperative symptoms, tumor size and location, disease recurrence, primary and secondary treatments, and survival time.

Results

Two patients were alive as of March 2008. The median survival time for patients primarily treated with surgical resection was 9.7 months compared to 7.9 months for patients initially treated with SRS. Solitary brain metastases and the absence of both preoperative hemorrhage and lung metastases served as prognostic factors increasing survival in both groups. Four patients undergoing primary treatment with SRS required subsequent surgical intervention secondary to radiation necrosis (3 patients) or local recurrence (1 patient). All 4 had lesions greater than 1.5 cm. For surgical patients, planned postoperative treatment with either radiosurgery or radiation therapy increased survival time to 12.3 months vs 7.3 months.

Conclusions

Patients with positive prognostic factors including solitary brain lesions, absence of hemorrhage preoperatively, and absence of lung disease are viable candidates for aggressive, surgical intervention followed by adjuvant therapy with radiosurgery or conventional radiation therapy. Other patients should be considered for more conservative treatment with radiosurgery or other palliative treatments.

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Surgical Neurology
Surgical Neurology 医学-临床神经学
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