Wowra Berndt, Muacevic Alexander, Tonn Jörg-Christian
European CyberKnife Center Munich, Max Lebsche Platz 31, Munich 81377, Germany.
J Neurooncol. 2009 Aug;94(1):69-77. doi: 10.1007/s11060-009-9802-y. Epub 2009 Feb 1.
A comparison of treatment parameters and quality of clinical outcome in patients with single brain metastases treated with two different technologies for radiosurgery (Gamma Knife and CyberKnife).
Treatment parameters were statistically analyzed. Clinical outcome was assessed by matched-pair analysis based on the treatment device, differences in dose prescription, and the date of the treatment. Patients were matched according to their tumor size, age, gender, primary cancer, and Radiation Therapy Oncology Group score. Survival post-radiosurgery, local and distant tumor control, and complications were analyzed. Predictive factors were investigated.
423 single brain metastases were treated with Gamma Knife and 73 with CyberKnife. Tumor volumes were similar. The parameters minimum tumor dose, maximum tumor dose, prescription isodose volume, conformality index, homogeneity index, volume of tissue receiving a dose of 10 Gy or more were significantly larger in Gamma Knife group. Sixty-three patients were good matches. These showed the same pattern in parameters. Concerning the outcome analysis, only overall survival differed significantly between groups, twice as long with CyberKnife (P < 0.03). According to pooled data, dose was predictive of local failure, whole brain radiation therapy and chemotherapy were predictive of toxicity, the Radiation Therapy Oncology Group score was predictive of survival after radiosurgery, and date of treatment was predictive of overall survival. No factor predicted new brain metastases, including whole brain radiation therapy.
The most important result of this study was the finding that the obvious differences in treatment-related parameters between Gamma Knife and CyberKnife had no impact on the quality of the clinical outcome after radiosurgery. Survival time increased chronologically, presumably due to an intensified anti-cancer therapy in the more recent era of the CyberKnife treatments.
比较采用两种不同放射外科技术（伽玛刀和射波刀）治疗的单发性脑转移瘤患者的治疗参数及临床结局质量。
对治疗参数进行统计学分析。基于治疗设备、剂量处方差异及治疗日期，通过配对分析评估临床结局。根据患者的肿瘤大小、年龄、性别、原发癌及放射治疗肿瘤学组评分进行配对。分析放射外科治疗后的生存期、局部和远处肿瘤控制情况以及并发症。研究预测因素。
423例单发性脑转移瘤患者接受了伽玛刀治疗，73例接受了射波刀治疗。肿瘤体积相似。伽玛刀组的最小肿瘤剂量、最大肿瘤剂量、处方等剂量体积、适形指数、均匀性指数、接受10 Gy或更高剂量的组织体积等参数显著更大。63例患者配对良好。这些患者在参数方面呈现相同模式。关于结局分析，两组之间仅总生存期存在显著差异，射波刀治疗的总生存期是伽玛刀治疗的两倍（P < 0.03）。根据汇总数据，剂量可预测局部失败，全脑放射治疗和化疗可预测毒性，放射治疗肿瘤学组评分可预测放射外科治疗后的生存期，治疗日期可预测总生存期。没有因素可预测新发脑转移瘤，包括全脑放射治疗。
本研究最重要的结果是发现伽玛刀和射波刀在治疗相关参数上的明显差异对放射外科治疗后的临床结局质量没有影响。生存时间按时间顺序增加，可能是由于在射波刀治疗的更近时期抗癌治疗得到了强化。
