Heckl S, Braun K, Van Kaick G, Kunze S, Debus J
German Cancer Research Center, Department of Neuroradiology, University of Heidelberg, Medical School, Germany.
Nervenarzt. 2002 Oct;73(10):967-71. doi: 10.1007/s00115-002-1400-6.
The case of a patient suffering from renal cell carcinoma and recurrent brain metastases shows how the survival period can be significantly prolonged by a combination of stereotactically guided percutaneous single-dose convergent beam irradiation and surgery. This 58-year-old man's left kidney was completely excised because of a renal cell carcinoma. After 18 months and 25 months, respectively, a right frontal brain metastasis was operated on. In the next 7 years, biannual MRI checks were carried out which successively showed five different brain metastases, each of which was immediately subjected to single-dose stereotactic irradiation (median dosage: 20 Gy prescribed to the 80% isodose). In the following 2 years, operations were carried out on two metastases which could not be treated by radiation because of their considerable size and partial compression of the ventricle. In the next 3 years, four more brain metastases were subjected to single-dose stereotactic irradiation. There were no metastases in the other organs. At present, the patient is in good clinical condition and mobile. A negative prognosis is usually delivered for patients suffering from renal cell carcinoma and brain metastasis. However, in individual cases, the survival period can be significantly prolonged by regular MRI examinations and a combination of neurosurgery and single-dose stereotactic irradiation.
一名患有肾细胞癌并伴有复发性脑转移瘤的患者病例显示，立体定向引导下经皮单剂量会聚束照射与手术相结合可显著延长生存期。这名58岁男性因肾细胞癌，左肾被完全切除。分别在18个月和25个月后，对右侧额叶脑转移瘤进行了手术。在接下来的7年里，每半年进行一次MRI检查，相继发现了5个不同的脑转移瘤，每个转移瘤均立即接受单剂量立体定向照射（中位剂量：80%等剂量线处规定为20 Gy）。在接下来的2年里，对两个因体积较大且部分压迫脑室而无法通过放疗治疗的转移瘤进行了手术。在接下来的3年里，又有4个脑转移瘤接受了单剂量立体定向照射。其他器官未发现转移瘤。目前，患者临床状况良好，行动自如。肾细胞癌伴脑转移的患者通常预后不良。然而，在个别病例中，通过定期MRI检查以及神经外科手术和单剂量立体定向照射相结合，生存期可显著延长。
