Curative Effect Observation Of Stereotactic Drainage And Gamma Knife Radiosurgery For Cystic Brain Metastasis

Background With the development of medic examination and treatment,the life of the patients with malignant tumor has been prolonged.Nowdays the incidence of brain metastases,which have become the most common intracranial tumors,is higher and higher.Brain metastases are more substantial,and some brain metastases of the tumor form cystic metastatic tumor due to hemorrhage and necrosis.Because most of the patients have nervous dysfunction and high intracranial pressure symptoms,brain metastases have gradually become one of the major diseases that have serious impact on people's life length and life quality.The occurrence of extracranial system malignant tumor's brain metastasis often suggests that the tumor lesions are in the advanced stage.Most of the patients with brain metastases from malignant tumors have a poor prognosis because of the particularity of the metastatic sites.For many years research,the early diagnosis and individualized treatment of brain metastases will significantly prolong the patients' survival time and improve their life quality.Objective The research of the treatment of minimally invasive and effective method for brain metastasis is through curative effect observation of stereotactic drainage and gamma knife radiosurgery for cystic brain metastasis,with the same volume of brain metastasis compared.Methods We analyzed retrospectively,between March 2013 and March 2015,Cystic and substantial brain metastasis patients treated by the Department of Neurosurgery of our hospital.In our study,the inclusion criteria included cystic brain metastasis r patients(n =19)is as group A,and the real brain metastasis tumor in 20 cases is as group B.The method,stereotactic drainage combined with gamma knife radiosurgery treatment,is applied to group A.And the method of stereotactic gamma knife treatment is applied to group B.No statistically significant differences about the size of the tumor volume,were found between group A after drainage and group B.Gamma knife radiotherapy dose of both groups were 12-18Gy(median dose of 15 Gy).Tumor volume and Karnofsky performance status(KPS)were recorded in both groups at the time of patients admitted to hospital and the moment after gamma knife treatment.The regular reexaminations after gamma knife treatment,every three months reexamine head MRI(Magnatic Resonance Imaging),tumor control rate and tumor control survival time were observed in both groups.Statistical analysis was performed using SPSS version 17.0,the measurement data use (?) ± s to express.t test was used to compare the survival of patients in each group and tumor control rate were compared with the ?2 test.Using Kaplan Meier analysis draw survival curves.Results were regarded as significant for P<0.05.Complete response(CR)was defined as “a complete disappearance of all enhancing tumors”,partial response(PR)as “?50% decrease in enhancing tumor volume”,progressive disease(PD)as “? 25% increase in enhancing tumor volume”,and stable disease(SD)as “< 50% decrease or <25% increase in enhancing tumor volume”.We defined local tumor control as “CR,PR,and SD”.Local tumor control rate =(CR+PR+SD)/ total number of cases × 100%.ResultsBy following the patients over 2-36 moths,survival time of patients among two groups were 10.55±5.37 months and 12.08±6.35 months(?2=0.105,P=0.305),respectively.Through six months' treatment,tumor's local-control rate of both groups were 69% and 75%(?2=0.208,P=0.460),respectively.Through twelve months' treatment,tumor's local control rate of both groups were 48% and 43%(?2=0.022,P=0.568)respectively.Tumor volumes of group A before and after the drainage operation were 36.5±15.2 cm~3 and 7.8±2.7 cm~3(P<0.05),respectively.Tumor volumes of group B was 7.8±1.5 cm~3,P>0.05 compared with the one of group A after the drainage.The KPS scores of the group A before and after the drainage were 63.7±7.6 points and 85.8±6 points(P<0.05),respectively.One patient with intracranial tumor progression occured in group A and craniotomy and resection were done.There were 6 cases of death in group A and 8 cases in group B.Sixty percent of the death causes were the primary tumor progression.Related complications did not exist among all the cases through the drainage operation and gamma knife radiosurgery treatment.Conclusion 1.The symptoms of stereotactic drainage for cystic metastases after compared with drainage before,the difference was statistically significant.2.Gamma knife radiosurgery after stereotactic aspiration for cystic brain metastases and equivalent volume of solid brain metastases gamma knife treatment of long curative effect,there was no statistically significant difference.