立体定向放射治疗（SRT）通常以多次分数（通常≤5）的方式可以有效地治疗广泛的脑转移瘤，包括那些不适合进行单次分数立体定向放射外科手术（SRS）的病例。以往关于立体定向辅助放射外科手术的前瞻性研究仅关注SRS，而回顾性研究显示手术是否与仅进行SRT相比具有改善疗效并无定论。将行手术切除后进行腔内SRT或SRS与仅进行SRT的疗效进行比较来观察病例的1个脑转移瘤病例的疗效，并同时设置接受仅进行SRS的患者作为参考组。我们在一项单中心机构的回顾性队列研究中研究了716名患有单个或孤立脑转移瘤的患者，这些患者是在2007年至2020年间诊断的。 排除了接受全脑放射治疗的患者。构建Cox比例风险模型以评估总体生存及其他颅内疾病结果。在调整潜在混杂因素后，手术切除后进行腔内SRT / SRS与仅进行SRT相比与全部死因死亡率减少有关（风险比[HR]：0.39，95％ CI [0.27-0.57]，P = 1.52×10-6），同时降低由颅内肿瘤进展致的神经死亡（HR：0.46，95％ CI [0.22-0.94]，P = 3.32×10-2）和放射性坏死的风险（HR：0.15，95％ CI [0.06-0.36]，P = 3.28×10-5）。手术切除后进行腔内SRS也与仅进行SRS相比降低了全因死亡（HR：0.52，95％ CI [0.35-0.78]，P = 1.46×10-3），神经死亡（HR：0.30，95％ CI [0.10-0.88]，P = 2.88×10-2）和放射性坏死的风险（HR：0.14，95％ CI [0.03-0.74]，P = 2.07×10-2）。手术与仅进行SRT相比在合适数量的队列中与降低全因死亡和神经死亡相关。在手术患者中，完整切除与延长总体生存相关（HR：0.62，95％ CI [0.40-0.98]，P = 4.02×10-2），同时与降低神经死亡（HR：0.31，95％ CI [0.17-0.57]，P = 1.84×10-4）和局部失败（HR：0.34，95％ CI [0.16-0.75]，P = 7.08×10-3）的风险有关。对于有1个脑转移瘤的患者来说，在进行立体定向放射治疗前，最小化颅内疾病与肿瘤有关的病灶数目与提高肿瘤学治疗效果有关。 版权所有©2023年神经外科医师大会。保留所有权利。

Stereotactic radiotherapy (SRT) in multiple fractions (typically ≤5) can effectively treat a wide range of brain metastases, including those less suitable for single-fraction stereotactic radiosurgery (SRS). Prior prospective studies on surgical resection with stereotactic radiation have focused exclusively on SRS, and retrospective studies have shown equivocal results regarding whether surgery is associated with improved outcomes compared with SRT alone.To compare surgical resection with postoperative cavity SRT or SRS to SRT alone in patients with 1 brain metastasis, while including patients receiving SRS alone as an additional reference group.We studied 716 patients in a retrospective, single-institution cohort diagnosed with single or solitary brain metastases from 2007 to 2020. Patients receiving whole-brain radiotherapy were excluded. Cox proportional hazards models were constructed for overall survival and additional intracranial outcomes.After adjustment for potential confounders, surgery with cavity SRT/SRS was associated with decreased all-cause mortality (hazard ratio [HR]: 0.39, 95% CI [0.27-0.57], P = 1.52 × 10-6) compared with SRT alone, along with lower risk of neurological death attributable to intracranial tumor progression (HR: 0.46, 95% CI [0.22-0.94], P = 3.32 × 10-2) and radiation necrosis (HR: 0.15, 95% CI [0.06-0.36], P = 3.28 × 10-5). Surgery with cavity SRS was also associated with decreased all-cause mortality (HR: 0.52, 95% CI [0.35-0.78], P = 1.46 × 10-3), neurological death (HR: 0.30, 95% CI [0.10-0.88], P = 2.88 × 10-2), and radiation necrosis (HR: 0.14, 95% CI [0.03-0.74], P = 2.07 × 10-2) compared with SRS alone. Surgery was associated with lower risk of all-cause mortality and neurological death in cardinality-matched subsets of the cohort. Among surgical patients, gross total resection was associated with extended overall survival (HR: 0.62, 95% CI [0.40-0.98], P = 4.02 × 10-2) along with lower risk of neurological death (HR: 0.31, 95% CI [0.17-0.57], P = 1.84 × 10-4) and local failure (HR: 0.34, 95% CI [0.16-0.75], P = 7.08 × 10-3).In patients with 1 brain metastasis, minimizing intracranial disease specifically before stereotactic radiation is associated with improved oncologic outcomes.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.