Lee Seung Heon, Lee Kyu Chan, Choi Jinho, Kim Hye Young, Lee Seok Ho, Sung Ki Hoon, Kim Yunmi
Department of Radiation Oncology, Gachon University Gil Hospital, Incheon, Korea.
Radiat Oncol J. 2012 Jun;30(2):53-61. doi: 10.3857/roj.2012.30.2.53. Epub 2012 Jun 30.
To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases.
Nine patients with multiple (≥4) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10-12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions.
The median biologically effective dose to metastatic tumors was 68.1 Gy(10) and 67.2 Gy(10) and the median brain volume irradiated more than 100 Gy(3) were 1.9% (24 cm(3)) and 0.8% (13 cm(3)) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively.
RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.
确定容积旋转调强放疗（RapidArc）在全脑放疗（WBRT）中对预后不良的有4个或更多脑转移瘤患者进行序贯或同步瘤床加量放疗的可行性。
分析9例有多个（≥4个）脑转移瘤的患者。3例在递归分区分析中被归类为II级，6例为III级。III级患者出现偏瘫、认知功能障碍或失用症。肿瘤与全脑体积之比为0.8 - 7.9%。6例患者接受二维双侧WBRT（30 Gy/10 - 12次分割），随后序贯容积旋转调强放疗瘤床加量（15 - 30 Gy/4 - 10次分割）。3例患者接受容积旋转调强放疗全脑放疗并同步对肿瘤加量（48 - 50 Gy），分10 - 20次分割。
转移瘤的中位生物等效剂量分别为68.1 Gy(10)和67.2 Gy(10)，每组中受照剂量超过100 Gy(3)的中位脑体积分别为1.9%（24 cm(3)）和0.8%（13 cm(3)）。治疗时间少于3分钟，容积旋转调强放疗很容易应用于身体状况较差的患者。随访期为0.3 - 16.5个月。6例接受随访磁共振成像检查的患者中，肿瘤反应分别为部分缓解3例、病情稳定3例。6个月和12个月时的总生存率分别为66.7%和41.7%。6个月和12个月时的局部无进展生存率分别为100%和62.5%。
容积旋转调强放疗作为全脑放疗的一部分用于预后不良的多发脑转移瘤患者，是一种有效、安全且易于应用的治疗方式。
