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Neurological Surgery No Shinkei Geka Volume 29, Issue 7 （July 2001）

Neurological Surgery 脳神経外科 29巻7号（2001年7月発行）

Japanese English

研究

Radiosurgery時代の肺癌脳転移に対する治療 Treatment for Brain Metastasis from Lung Cancer in the Era of Radiosurgery 山中一浩 ¹ , 岩井謙育 ¹ , 中島英樹 ¹ , 安井敏裕 ¹ , 小宮山雅樹 ¹ , 西川節 ¹ , 森川俊枝 ¹ , 岸廣成 ¹ , 根来俊一 ² , 多田弘人 ³ , 田中正博 ⁴ Kazuhiro YAMANAKA ¹ , Yoshiyasu IWAI ¹ , Hideki NAKAJIMA ¹ , Toshihiro YASUI ¹ , Masaki KOMIYAMA ¹ , Misao NISHIKAWA ¹ , Toshie MORIKAWA ¹ , Hiroshige KISHI ¹ , Shun-ichi NEGORO ² , Hirohito TADA ³ , Masahiro TANAKA ⁴ ¹大阪市立総合医療センター脳神経外科 ²大阪市立総合医療センター呼吸器内科 ³大阪市立総合医療センター呼吸器外科 ⁴大阪市立総合医療センター放射線科 ¹Department of Neurosurgery, Osaka City General Hospital ²Department of Pulmonary Medicine, Osaka City General Hospital ³Department of General Thoracic Surgery, Osaka City General Hospital ⁴Department of Radiology, Osaka City General Hospital キーワード： brain metastasis , lung cancer , radiosurgery , gamma knife radiosurgery Keyword: brain metastasis , lung cancer , radiosurgery , gamma knife radiosurgery pp.617-623

発行日 2001年7月10日 Published Date 2001/7/10

DOI https://doi.org/10.11477/mf.1436902065

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Abstract 文献概要
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I．はじめに

　高齢化社会への移行，癌治療，画像診断の進歩などにより転移性脳腫瘍を治療する機会が増加してきている^5）．最近ガンマナイフを含めたradio-Surgeryが非侵襲的に施行でき，かつ種々の脳腫瘍などに対して高い有効性を示すことが明らかとなってきた^{1,3,4,8-10,14,15,17）}．Radiosurgeryの登場により転移性脳腫瘍の治療方針も大きく変化してきているが，当施設においてガンマナイフを導入した後5年間における肺癌脳転移の治療方法と成績につき検討し，その治療方針について考察を加える．

Objective: The treatment for brain metastasis has undergone remarkable changes since the developmentof radiosurgery. We investigated the results of treatment for brain metastasis from lung cancer since the in-itiation of gamma knife radiosurgery (GKRS) and we discuss the usefulness of GKRS combined withother treatments in cases with recurrence.

Methods: We treated 142 patients with brain metastasis from lung cancer. Sixteen patients were treatedsurgically,11 patients were treated with whole brain radiation therapy (WBRT),and 115 patients were tre-ated with GKRS. Our treatment plan is to use GKRS in cases with less than 5 lesions and lesions less than3 cm in mean diameter. We use WBRT in cases with 5 or more lesions, and surgery in cases with lesions 3cm or larger. If new lesions or tumor regrowth appeared after the initial treatment, we retreated them withone of the methods mentioned above.

Results: Twice or three,time treatments were performed in 30 patients. Median survival including all caseswas 10 months and the number of deaths due to local treatment failure was only 5(6.5%) out of the total77 deaths which occurred.

Conclusion: We were able to carry out less invasive treatment for brain metastasis from lung cancer byutilizing GKRS. Though we have to consider the indications for other treatments, we can say thatradiosurgery is usually the treatment of first choice for brain metastasis from lung cancer. When new le-sions appear in cases where a particular initial treatment was used, it is possible to maintain or improve thequality of life by retreatment, using a combination of GKRS, surgery or WBRT, to prolong the patient'slife.