Background: The role of stereotactic radiosurgery (SRS) for patients with brain metastases from hepatopancreaticobiliary (HPB) cancers has yet to be established. The authors present a single-institution experience of patients with HPB cancers who underwent SRS when their cancer spread to the brain. Methods: We surveyed our Gamma Knife SRS data base of 18,000 patients for the years 1987–2022. In total, 19 metastatic HPB cancer patients (13 male) with 76 brain metastases were identified. The median age at SRS was 61 years (range: 48–83). The primary cancer sites were hepatocellular carcinoma (HCC, 11 patients), cholangiocarcinoma (CCC, 2 patients), and pancreatic carcinoma (PCC, 6 patients). The median Karnofsky Performance Score (KPS) was 80 (range: 50–90). Two patients underwent pre-SRS whole-brain fractionated radiation therapy (WBRT) and eight patients underwent pre-SRS surgical resection. All SRS was delivered in single session. The median margin dose was 18 Gy (range: 15–20). The median cumulative tumor volume was 8.1 cc (range: 1.0–44.2). Results: The median patient overall survival (OS) after SRS was 7 months (range 1–79 months). Four patients had documented local tumor progression after SRS at a median time of 8.5 months (range: 2–15) between SRS and progression. Out of 76 treated tumors, 72 tumors exhibited local control. The local tumor control rate per patient was 78.9%. The local tumor control per tumor was 94.7%. Four patients developed new brain metastases at a median of 6.5 months (range: 2–17) after SRS. No patient experienced adverse radiation effects (AREs). At the last follow-up, 18 patients had died, all from systemic disease progression. Conclusions: Metastatic spread to the brain from HPB cancers occurs late in the course of the primary disease. In this study, all deceased patients ultimately died from primary disease progression. SRS is a non-invasive strategy that maximally preserves quality of life, and our results reported favorable outcomes compared to the existing literature. SRS should be considered as one of the primary management strategies for patients with brain metastatic spread from HPB cancer.
背景：立体定向放射外科（SRS）在肝胰胆（HPB）癌脑转移患者中的作用尚未明确。本研究回顾性分析单中心HPB癌脑转移患者接受SRS治疗的临床经验。方法：检索本中心1987年至2022年间伽玛刀SRS数据库（含18,000例患者），共纳入19例（男性13例）HPB癌脑转移患者，累计脑转移灶76个。SRS治疗中位年龄61岁（范围：48-83岁）。原发癌类型包括肝细胞癌（HCC，11例）、胆管癌（CCC，2例）和胰腺癌（PCC，6例）。中位卡氏功能状态评分（KPS）为80分（范围：50-90分）。2例患者SRS前行全脑分次放疗（WBRT），8例患者SRS前接受手术切除。所有SRS治疗均为单次完成，中位边缘剂量18 Gy（范围：15-20 Gy），中位累积肿瘤体积8.1 cc（范围：1.0-44.2 cc）。结果：患者SRS治疗后中位总生存期（OS）为7个月（范围：1-79个月）。4例患者出现局部肿瘤进展，SRS至进展的中位时间为8.5个月（范围：2-15个月）。76个治疗病灶中72个获得局部控制，患者层面局部控制率为78.9%，病灶层面局部控制率为94.7%。4例患者在SRS后中位6.5个月（范围：2-17个月）出现新发脑转移灶。所有患者均未发生放射性不良反应（AREs）。末次随访时18例患者死亡，死因均为全身性疾病进展。结论：HPB癌脑转移通常发生于原发疾病晚期。本研究中所有死亡患者最终均死于原发疾病进展。SRS作为非侵入性治疗手段能最大程度保护患者生活质量，本研究结果较现有文献报道更具优势。对于HPB癌脑转移患者，SRS应被视为重要的治疗策略之一。
Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers
肿瘤(癌症)患者之家