Kamath Reena, Ryken Timothy C, Meeks Sanford L, Pennington Edward C, Ritchie Justine, Buatti John M
Department of Radiation Oncology, University of Iowa College of Medicine, Iowa City, IA, USA.
Int J Radiat Oncol Biol Phys. 2005 Apr 1;61(5):1467-72. doi: 10.1016/j.ijrobp.2004.08.021.
To review the initial clinical experience with frameless stereotactic radiosurgery (SRS) for treating intracranial metastatic disease.
Sixty-four patients received frameless SRS for intracranial metastatic disease. Minimum follow-up was 6 months with none lost to follow-up. Patients had a median of 2 metastases and a maximum of 4. The median number of isocenters was 2 with median arcs of 10 and median dose of 17.5 Gy. Thirteen patients were treated for progressive/recurrent disease after surgical resection or whole brain radiotherapy (WBRT). Fifty-one patients were treated with frameless SRS as an an adjunct to initial treatment. Of the total treated, 17 were treated with SRS alone, 20 were treated with WBRT plus SRS, 16 were treated with surgical resection plus SRS, and the remaining 11 were treated with surgical resection plus WBRT plus SRS.
With a median actuarial follow-up period of 8.2 months, ultimate local control was 88%. The median time to progression was 8.1 months. The median overall survival was 8.7 months. Of the 17 patients treated with SRS alone, 86% had ultimate local control with mean overall survival of 7.1 months. Of the 13 patients who received surgical resection plus SRS without WBRT as primary treatment, there was 85% ultimate local control with an overall survival of 10.3 months. Three patients treated with initial surgery alone had recurrence treated with SRS 2-3 months after resection. All these patients obtained local control and median survival was >10 months. Of the 13 patients who received WBRT followed by SRS as boost treatment, 92% had local control and mean overall survival was 7.3 months. Of 7 patients who received SRS after recurrence after WBRT, 100% had local control with median survival of 8.2 months. For 8 patients who received surgery followed by WBRT and SRS, local control was 50%; however, ultimate intracranial control was achieved in 7 of 8 patients with repeat SRS and surgical resection. The overall survival in this group of patients was 14.7 months. No patient had a serious (Grade 3 or higher) complication requiring intervention.
Frameless optically guided radiosurgery is less invasive, can be performed as a standard radiotherapy-based simulation procedure, and maintains submillimetric accuracy. Our initial results with frameless SRS for metastatic disease suggest survival times and local control (88%) eqiuvalent to frame-based methodologies. Practical noninvasive delivery makes treatment and potential retreatment to avoid WBRT more feasible.
回顾无框架立体定向放射外科（SRS）治疗颅内转移性疾病的初步临床经验。
64例患者接受了无框架SRS治疗颅内转移性疾病。最短随访时间为6个月，无失访病例。患者转移灶中位数为2个，最多4个。等中心点中位数为2个，弧度数中位数为10个，中位剂量为17.5 Gy。13例患者在手术切除或全脑放疗（WBRT）后因疾病进展/复发接受治疗。51例患者接受无框架SRS作为初始治疗的辅助治疗。在所有接受治疗的患者中，17例仅接受SRS治疗，20例接受WBRT加SRS治疗，16例接受手术切除加SRS治疗，其余11例接受手术切除加WBRT加SRS治疗。
中位精算随访期为8.2个月，最终局部控制率为88%。进展的中位时间为8.1个月。中位总生存期为8.7个月。在仅接受SRS治疗的17例患者中，86%获得了最终局部控制，平均总生存期为7.1个月。在13例作为主要治疗接受手术切除加SRS而未接受WBRT的患者中，最终局部控制率为85%，总生存期为10.3个月。3例仅接受初始手术治疗的患者在切除后2 - 3个月复发并接受SRS治疗。所有这些患者均获得局部控制，中位生存期>10个月。在13例接受WBRT后再接受SRS作为强化治疗的患者中，92%获得局部控制，平均总生存期为7.3个月。在7例WBRT后复发并接受SRS治疗的患者中，100%获得局部控制，中位生存期为8.2个月。对于8例接受手术、WBRT和SRS治疗的患者，局部控制率为50%；然而，8例患者中有7例通过重复SRS和手术切除实现了最终颅内控制。该组患者的总生存期为14.7个月。没有患者出现需要干预的严重（3级或更高）并发症。
无框架光学引导放射外科侵入性较小，可作为基于标准放疗的模拟程序进行，且保持亚毫米级精度。我们使用无框架SRS治疗转移性疾病的初步结果表明，生存时间和局部控制率（88%）与基于框架的方法相当。实用的非侵入性治疗方式使治疗及为避免WBRT而进行的潜在再治疗更加可行。
