直线加速器放射外科治疗肾细胞癌脑转移瘤

LINAC radiosurgery for brain metastasis of renal cell carcinoma.

作者信息

Noel Georges, Valery Charles-Ambroise, Boisserie Gilbert, Cornu Philippe, Hasboun Dominique, Marc Simon Jean, Tep Bernadette, Ledu Dominique, Delattre Jean-Yves, Marsault Claude, Baillet François, Mazeron Jean-Jacques

机构信息

Department of Radiation Oncology, Groupe Pitié-Salpêtrière, AP-HP, 47-83, Bd de l'hôpital, 75651 Paris Cedex 13, France.

出版信息

Urol Oncol. 2004 Jan-Feb;22(1):25-31. doi: 10.1016/S1078-1439(03)00104-2.

DOI:10.1016/S1078-1439(03)00104-2

PMID:14969800

Abstract

The purpose of the study was to evaluate the efficacy and toxicity of stereotactic radiotherapy in the treatment of the brain metastasis of renal cell carcinoma. From 1994 to 2001, 28 patients presenting with 65 metastases of renal cell cancer were treated by radiosurgery. Median age was 55 years (35-75), and median Karnofski performance status ranges between 50 and 100. Seven patients had received whole brain radiotherapy (WBRT) before radiosurgery. Twelve patients were treated by radiosurgery for 1 metastasis, 5 patients for two metastases and 6 for three, and 5 for more than three metastases. One procedure was performed in 22 patients and, 2 or 3 procedures for 6 patients. Median metastasis diameter was 19 mm (5-55 mm). Median metastasis volume was 1.28 cc (0.02-28 cc). Irradiation was delivered by linear accelerator. Median minimal dose (on the 70% isodose) was 14.7 Gy (10.8 Gy, 19.5 Gy), median maximal dose (at the isocenter) 20.5 Gy (14.3 Gy, 39.6 Gy). Median follow-up was 14 months (1-33). Two metastases progressed (3%), 2 and 12 months after radiosurgery. Overall, crude local control rate was 97% and 3-, 6- and 12-month local control rates were 98% +/- 2%, 98% +/- 2%, and 93% +/- 5%, respectively. In univariate analysis, no prognostic factor of local control was retrieved. Median brain disease-free survival was 25 months after RS. the 3-, 6- and 12-month distant brain control rates were 91% +/- 4%, 91% +/- 4%, and 70% +/- 12%, respectively. Median survival duration was 11 months. The 3-, 6-, 12- and 24-month overall survival rates were 82% +/- 7%, 67% +/- 9%, 48% +/- 10%, and 33% +/- 10%, respectively. According to univariate analysis, only site of metastasis was overall survival prognostic factor. Radiosurgery for brain metastasis of renal cell carcinoma is an effective and accurate treatment. The use of radiosurgery alone is an appropriate management strategy for many patients with brain metastasis of renal cell carcinoma. Radiosurgery is efficient even after development of new metastasis appearing after WBRT.

摘要

本研究的目的是评估立体定向放射治疗在肾细胞癌脑转移治疗中的疗效和毒性。1994年至2001年，28例出现65处肾细胞癌转移灶的患者接受了放射外科治疗。中位年龄为55岁（35 - 75岁），中位卡诺夫斯基功能状态评分在50至100之间。7例患者在放射外科治疗前接受过全脑放疗（WBRT）。12例患者因1处转移灶接受放射外科治疗，5例因2处转移灶，6例因3处转移灶，5例因3处以上转移灶接受治疗。22例患者进行了1次治疗，6例患者进行了2次或3次治疗。转移灶中位直径为19毫米（5 - 55毫米）。转移灶中位体积为1.28立方厘米（0.02 - 28立方厘米）。采用直线加速器进行照射。中位最小剂量（在70%等剂量线上）为14.7 Gy（10.8 Gy，19.5 Gy），中位最大剂量（在等中心处）为20.5 Gy（14.3 Gy，39.6 Gy）。中位随访时间为14个月（1 - 33个月）。2处转移灶在放射外科治疗后2个月和12个月出现进展（3%）。总体而言，粗局部控制率为97%，3个月、6个月和12个月的局部控制率分别为98%±2%、98%±2%和93%±5%。单因素分析未发现局部控制的预后因素。放射外科治疗后中位无脑部疾病生存期为25个月。3个月、6个月和12个月的远处脑部控制率分别为91%±4%、91%±4%和70%±12%。中位生存期为11个月。3个月、6个月、12个月和24个月的总生存率分别为82%±7%、67%±9%、48%±10%和33%±10%。单因素分析显示，仅转移部位是总生存的预后因素。肾细胞癌脑转移的放射外科治疗是一种有效且精确的治疗方法。对于许多肾细胞癌脑转移患者，单独使用放射外科治疗是一种合适的治疗策略。即使在WBRT后出现新的转移灶，放射外科治疗仍然有效。