Treatment of single brain metastasis: Radiotherapy alone or combined with neurosurgery

作者：Charles J. Vecht, Hanny Haaxma-Reiche, Evert M. Noordijk, George W. Padberg, Joan H. C. Voormolen, Foppe H. Hoekstra, J. T. J. Tans, Nanno Lambooij, Jan A. L. Metsaars, A. Rolf Wattendorff, Ronald Brand, J. Hermans · 发表于：Annals of Neurology · 年份：1993 · DOI：10.1002/ana.410330605 · 被引用次数：1055 · 研究领域：Brain Metastases and Treatment、Glioma Diagnosis and Treatment、Lung Cancer Research Studies

Abstract Most patients treated for single or multiple brain metastases die from progression of extracranial tumor activity. This makes it uncertain whether the combination of neurosurgery and radiontherapy for treatment of single brain metastasis will lead to better results than less invasive treatment with radiotherapy alone. The effect of neurosurgical excision plus radiotherapy was compared with radiotherapy alone in a prospectively randomized trial with 63 evaluable patients with systemic cancer and a radiological diagnosis of single brain metastasis. Radiotherapy was given to the whole brain by a novel scheme of 2 faractions per day of each 2 Gy for a total of 40 Gy. Before randomization, patients were stratified by site (lung cancer vs nonlung cancer) and status of extracranial disease (progressive vs. stable). Survival as such and functionally independent survival (FIS; defined as world Health Organization performance status ≤ 1 and neurological funcition ≤ 1) were compared between both treatment arms. The combined treatment compared with radiotherapy alone led to a longer survival ( p =0.04) and a longer FIS ( p =0.06). This was most pronounced in patients with stable extracranial disease (median survival, 12vs 7 mo; median FIS 9 vs 4 Mo). Patients with progressive extracranial cancer had a median overall survival of 5 months and a FIS of 2.5 months irrespective of given treatment. Improvement in functional status occurred more rapidly and for longer periods of time a...