Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany.
Strahlenther Onkol. 2011 Jan;187(1):7-14. doi: 10.1007/s00066-010-2168-4. Epub 2010 Dec 22.
To compare stereotactic brachytherapy (SBT) with stereotactic radiosurgery (SRS) for treating singular cerebral metastases, regarding feasibility, complications, cerebral disease control, and survival.
For this retrospective, single-center study, all patients treated for newly diagnosed, untreated singular cerebral metastasis with SBT using (125)iodine seeds (cumulative tumor surface dose 50 Gy, applied for 42 days) were compared with patients receiving LINAC-based SRS for the same indication. Survival and actuarial local and distant disease control were evaluated using univariate Kaplan-Meier estimates and Cox regression. Results were compared using Student's t test and the χ2 test.
A total of 142 patients treated with SRS were compared with 77 patients undergoing SBT. No significant differences were observed between epidemiological and disease-related features (p > 0.05), except a lower KPS (p < 0.007) and a larger tumor volume (p < 0.001) in the SBT group. Neither median survival (LINAC-SRS vs. SBT = 8.1 vs. 8.0 months, respectively) nor actuarial local/distant cerebral disease control after 12 months showed significant differences (93.6% vs. 96.7% / 42.4% vs. 46.4%). There was no treatment-related mortality and no permanent grade 3 or 4 CNS toxicity (RTOG/EORTC CNS toxicity criteria).
For the treatment of singular cerebral metastasis, SBT represents a safe, minimally invasive, and effective local treatment option with results comparable to SRS regarding survival and cerebral disease control. Its advantage is that it allows histological (re-)evaluation and treatment within one stereotactic procedure and, compared to microneurosurgery, is almost unrestricted regarding tumor localization. Furthermore, larger metastases can be treated than with SRS. SBT, therefore, represents an alternative local treatment in selected cases.
比较立体定向近距离放疗（SBT）和立体定向放射外科（SRS）治疗单发脑转移瘤的可行性、并发症、脑内疾病控制和生存率。
本回顾性单中心研究比较了 142 例接受 LINAC 立体定向 SRS 治疗的患者与 77 例接受 SBT 治疗的患者。采用单变量 Kaplan-Meier 估计和 Cox 回归评估生存和局部及远处疾病的累积控制率。结果采用 Student's t 检验和 χ2 检验进行比较。
在 SRS 组中，未观察到与流行病学和疾病相关特征（p>0.05）之间的显著差异，除了 SBT 组的 KPS 较低（p<0.007）和肿瘤体积较大（p<0.001）。SBT 组和 SRS 组的中位生存时间（分别为 8.0 个月和 8.1 个月）和 12 个月时的局部/远处脑疾病控制率（分别为 96.7%和 93.6%/46.4%和 42.4%）均无显著差异。无治疗相关死亡，无永久性 3 或 4 级中枢神经系统毒性（RTOG/EORTC CNS 毒性标准）。
对于单发脑转移瘤的治疗，SBT 是一种安全、微创且有效的局部治疗选择，其在生存和脑内疾病控制方面与 SRS 结果相当。SBT 的优势在于它允许在一个立体定向过程中进行组织学（重新）评估和治疗，并且与微创手术相比，对肿瘤定位几乎没有限制。此外，与 SRS 相比，可以治疗更大的转移瘤。因此，在选择病例中，SBT 是一种替代的局部治疗方法。
