脑转移瘤的伽玛刀治疗

目的 评价伽玛刀治疗颅内脑转移瘤的疗效,分析能够预测预后生存率的因素.方法 407例脑转移瘤患者接受了伽玛刀治疗,随访344例,共756个病灶,肿瘤体积平均为(8.2±5.1)cm3,中心剂量和周边剂量分别(27.1±4.9)Gy和(15.4±2.0)Gy.对计数资料用X2检验,生存分析采用Kaplan-Meier曲线.结果 经过平均(17.7±9.8)个月的随访,影像学提示肿瘤消失140个、缩小331个、不变222个、增大63个.死亡病例114(33.1%)例,伽玛刀治疗后的平均生存期为(12.1±6.0)个月.年龄＜65岁、单发脑转移瘤、KPS≥70的患者有较好的生存率,且具有统计学意义(P＜0.01).结论 伽玛刀治疗脑转移瘤具有良好的控制率.年龄＜65岁、无颅外病变加重、KPS评分≥70、转移瘤灶少、原发灶控制,是具有良好生存期的预后因素.

Gamma knife surgery for the treatment of brain metastases

Objective The goal of this study was to evaluate the efficacy of gamma knife surgery (GKS)in the treatment of intracranial metastatic lesions and analyze prognostic factors that predict survival.Method 407 patients with brain metastases underwent gamma knife surgery.Follow up studies were available in 344 patients with 756 treated lesions.The mean seize of the tumors was(8.2±5.1)cm3.The maximum and margin doses used were(27.1±4.9)Gy and(15.4±2.0)Gy,respectively.Results After a mean of(17.7±9.8)months follow-up evaluation,imaging studies showed that the tumors disappeared in 140,shrank in 331,remained unchanged in 222,and grew in 63.The mean survival was(12.1±6.0)months after GKS.Survival was better in patients with younger age(＜65yrs),single brain metastasis and a Karnofsky performance SCale(KPS)≥70.Each has statistical significance(P＜0.01).Conclusions GKS is effective for metastatic brain tumors,which is safe and provides a high local tumor control rate.The better prognostic predictors for longer survival were younger age(＜65yrs),absence of extracranial worse disease,a good KPS score(≥70).fewer numbers of metastases and original lesion fully controlled.