Do Ly, Pezner Richard, Radany Eric, Liu An, Staud Cecil, Badie Benham
Department of Radiation Oncology, University of California, Irvine, School of Medicine, Orange, CA, USA.
Int J Radiat Oncol Biol Phys. 2009 Feb 1;73(2):486-91. doi: 10.1016/j.ijrobp.2008.04.070. Epub 2008 Oct 14.
In patients who undergo resection of central nervous system metastases, whole brain radiotherapy (WBRT) is added to reduce the rates of recurrence and neurologic death. However, the risk of late neurotoxicity has led many patients to decline WBRT. We offered adjuvant stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) as an alternative to select patients with resected brain metastases.
We performed a retrospective review of patients who underwent brain metastasis resection followed by SRS/SRT. WBRT was administered only as salvage treatment. Patients had one to four brain metastases. The dose was 15-18 Gy for SRS and 22-27.5 Gy in four to six fractions for SRT. Target margins were typically expanded by 1 mm for rigid immobilization and 3 mm for mask immobilization. SRS/SRT involved the use of linear accelerator radiosurgery using the IMRT 21EX or Helical Tomotherapy unit.
Between December 1999 and January 2007, 30 patients diagnosed with intracranial metastases were treated with resection followed by SRS or SRT to the resection cavity. Of the 30 patients, 4 (13.3%) developed recurrence in the resection cavity, and 19 (63%) developed recurrences in new intracranial sites. The actuarial 12-month survival rate was 82% for local recurrence-free survival, 31% for freedom from new brain metastases, 67% for neurologic deficit-free survival, and 51% for overall survival. Salvage WBRT was performed in 14 (47%) of the 30 patients.
Our results suggest that for patients with newly diagnosed brain metastases treated with surgical resection, postoperative SRS/SRT to the resection cavity is a feasible option. WBRT can be reserved as salvage treatment with acceptable neurologic deficit-free survival.
在接受中枢神经系统转移瘤切除术的患者中，加用全脑放疗（WBRT）以降低复发率和神经源性死亡率。然而，迟发性神经毒性风险致使许多患者拒绝接受WBRT。我们提供辅助立体定向放射外科治疗（SRS）或立体定向放疗（SRT）作为一种替代方案，用于筛选接受过脑转移瘤切除术的患者。
我们对接受脑转移瘤切除术后行SRS/SRT的患者进行了回顾性研究。WBRT仅作为挽救性治疗使用。患者有1至4个脑转移瘤。SRS的剂量为15 - 18 Gy，SRT分4至6次给予22 - 27.5 Gy。对于刚性固定，靶区边界通常扩大1 mm，对于面罩固定则扩大3 mm。SRS/SRT采用IMRT 21EX直线加速器放射外科或螺旋断层放疗设备进行。
1999年12月至2007年1月期间，30例诊断为颅内转移瘤的患者接受了切除术，随后对切除腔进行SRS或SRT治疗。在这30例患者中，4例（13.3%）在切除腔内出现复发，19例（63%）在新的颅内部位出现复发。局部无复发生存的精算12个月生存率为82%，无新脑转移的生存率为31%，无神经功能缺损生存的生存率为67%，总生存率为51%。30例患者中有14例（47%）接受了挽救性WBRT。
我们的结果表明，对于新诊断的脑转移瘤患者，手术切除后对切除腔进行术后SRS/SRT是一种可行的选择。WBRT可留作挽救性治疗，其无神经功能缺损生存情况可接受。
