Yoshikawa K, Saito K, Kajiwara K, Nomura S, Ishihara H, Suzuki M
Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan.
Minim Invasive Neurosurg. 2006 Apr;49(2):110-5. doi: 10.1055/s-2006-932183.
The CyberKnife is a new frameless image-guided radiosurgical modality. The authors report on their experience using the CyberKnife in 25 patients with malignant gliomas.
Twenty-five patients with histologically proven malignant gliomas (18 glioblastoma: GB, 7 anaplastic astrocytoma: AA) were treated with the CyberKnife at Konan St. Hill Hospital between June 1998 and November 2002. CyberKnife therapy was performed on 44 lesions (31 GB lesions, 13 AA lesions) in the 25 patients. The median target volume was 19.1 mL (range: 0.3 - 90.2). The median prescribed dose was 20.3 Gy (range: 13.9 - 26.4). Patient-, tumor-, and treatment-related variables were analyzed by univariate analysis, and survival curves were generated by the Kaplan-Meier product limit.
In the 18 GB patients, the median survival after diagnosis was 20.7 months (82.6 weeks) with a mean follow-up of 85.7 weeks. Of the 7 AA patients, 6 were alive at the time of analysis with follow-up periods ranging from 11.4 to 52.8 months. Patients younger than 70 years had a median survival after diagnosis of 37.1 months, compared to 12.4 months for older patients (p = 0.003). Similarly, patients with well-controlled lesions had a median survival after diagnosis of 39.8 months compared to 16.0 months for those with uncontrolled lesions (p = 0.031). Late delayed radiation necrosis was seen in 1 GB patient. No other patient suffered acute or delayed neurological morbidity after CyberKnife therapy.
This is the first report of CyberKnife stereotactic radiotherapy applied to the treatment of malignant gliomas. The frameless and painless CyberKnife stereotactic radiotherapy has the potential to be as useful for treatment of malignant glioma as other radiosurgical modalities.
射波刀是一种新型的无框架影像引导放射外科治疗设备。作者报告了他们使用射波刀治疗25例恶性胶质瘤患者的经验。
1998年6月至2002年11月期间，在小南圣希尔医院对25例经组织学证实的恶性胶质瘤患者（18例胶质母细胞瘤：GB，7例间变性星形细胞瘤：AA）使用射波刀进行治疗。对这25例患者的44个病灶（31个GB病灶，13个AA病灶）进行了射波刀治疗。中位靶体积为19.1毫升（范围：0.3 - 90.2）。中位处方剂量为20.3 Gy（范围：13.9 - 26.4）。通过单因素分析对患者、肿瘤和治疗相关变量进行分析，并采用Kaplan-Meier乘积限法生成生存曲线。
18例GB患者诊断后的中位生存期为20.7个月（82.6周），平均随访85.7周。7例AA患者中，6例在分析时存活，随访期为11.4至52.8个月。70岁以下患者诊断后的中位生存期为37.1个月，而70岁以上患者为12.4个月（p = 0.003）。同样，病灶控制良好的患者诊断后的中位生存期为39.8个月，而病灶未得到控制的患者为16.0个月（p = 0.031）。1例GB患者出现晚期迟发性放射性坏死。射波刀治疗后，没有其他患者出现急性或迟发性神经功能障碍。
这是关于射波刀立体定向放射治疗应用于恶性胶质瘤治疗的首次报告。无框架且无痛的射波刀立体定向放射治疗对于恶性胶质瘤的治疗可能与其他放射外科治疗方式同样有效。
