Hillard Virany H, Shih Lynn L, Chin Shing, Moorthy Chitti R, Benzil Deborah L
Department of Neurosurgery, New York Medical College, Valhalla, NY 10595, USA.
J Neurooncol. 2003 Jul;63(3):271-8. doi: 10.1023/a:1024251721818.
Stereotactic radiosurgery (SRS) is a widely used therapy for multiple brain lesions, and studies have clearly established the safety and efficacy of single-dose SRS. However, as patient survival has increased, the recurrence of tumors and the development of metastases to new sites within the brain have made it desirable to repeat treatments over time. The cumulative toxicity of multi-isocenter, multiple treatments has not been well defined. We have retrospectively studied 10 patients who received multiple SRS treatments for multiple brain lesions to assess the cumulative toxicity of these treatments.
In a retrospective review of all patients treated with SRS using the X-knife (Radionics, Burlington, MA) at Westchester Medical Center/New York Medical College between December 1995 and December 2000, 10 patients were identified who received at least two treatments to at least 3 isocenters and had a minimum follow-up period of 6 months. Image fusion technique was used to determine cumulative doses to targeted lesions, whole brain and critical brain structures. Toxicities and complications were identified by chart and radiological review.
The average of the maximum doses (cGy) to a point within the whole brain was 2402 (range 1617-3953); to the brainstem, 1059 (range 48-4126); to the right optic nerve, 223 (range 14-1012); to the left optic nerve, 159 (range 17-475); and to the optic chiasm, 219 (range 15-909). There were no focal neurological toxicities, including visual disturbances, cranial nerve palsies, or ataxia in any of the 10 patients. There were also no global toxicities, including cognitive decline or secondary tumors. Only one patient developed seizures that were difficult to control in association with radiation necrosis.
Multiple SRS treatments at the cumulative doses used in our study are a safe therapy for patients with multiple brain lesions.
立体定向放射外科（SRS）是一种广泛应用于治疗多发性脑病变的疗法，多项研究已明确证实单次剂量SRS的安全性和有效性。然而，随着患者生存期的延长，肿瘤复发以及脑内新部位转移灶的出现使得重复治疗变得必要。多中心、多次治疗的累积毒性尚未得到明确界定。我们回顾性研究了10例因多发性脑病变接受多次SRS治疗的患者，以评估这些治疗的累积毒性。
回顾性分析1995年12月至2000年12月期间在韦斯特切斯特医疗中心/纽约医学院使用X刀（Radionics，伯灵顿，马萨诸塞州）接受SRS治疗的所有患者，确定10例接受至少两次治疗至至少3个等中心且最短随访期为6个月的患者。采用图像融合技术确定靶病变、全脑和关键脑结构的累积剂量。通过病历和影像学检查确定毒性和并发症。
全脑内一点的最大剂量（cGy）平均值为2402（范围1617 - 3953）；脑干为1059（范围48 - 4126）；右侧视神经为223（范围14 - 1012）；左侧视神经为159（范围17 - 475）；视交叉为219（范围15 - 909）。10例患者中均未出现局灶性神经毒性，包括视觉障碍、颅神经麻痹或共济失调。也未出现全身性毒性，包括认知功能下降或继发性肿瘤。只有1例患者因放射性坏死出现难以控制的癫痫发作。
在我们的研究中，采用累积剂量的多次SRS治疗对多发性脑病变患者是一种安全的治疗方法。
