Department of Radiation Oncology, Center for Advanced Radiotherapy Technologies, University of California San Diego, La Jolla, California 92093-0843, USA.
Neurosurgery. 2012 Oct;71(4):844-51. doi: 10.1227/NEU.0b013e3182647ad5.
Frameless stereotactic radiosurgery is commonly used to treat intracranial metastases, but mask-based immobilization can be uncomfortable for patients.
To describe the clinical outcomes using a novel real-time, frameless, surface imaging--guided radiosurgery (SIG-RS) technique to treat brain metastases.
Data were prospectively gathered for 44 consecutive patients totaling 115 intracranial metastases treated with SIG-RS in a median of 1 fraction (range, 1-5) to a median dose of 20 Gy (range, 15-30 Gy). Local control, regional control, and overall survival were estimated by the Kaplan-Meier method.
Median follow-up for all patients was 6.0 months (range, 0.3-21.6 months), with 31 of 44 (70%) deceased at the time of analysis. The 35 patients (80%) with follow-up imaging totaled 88 lesions evaluable for local control. Actuarial 6- and 12-month local control was 90% (95% confidence interval, 82-98) and 76% (95% confidence interval, 60-91), respectively. Regional failure was observed in 16 patients (46%). The median actuarial overall survival was 7.7 months (95% confidence interval, 5.7-9.7). Analysis of the subset of 22 patients (55 lesions) who received SIG-RS alone (no prior treatment) in a single fraction yielded comparable clinical outcomes. Grade 3 or greater toxicity occurred in 4 patients (9%). The median treatment time from beam on to beam off was 15 minutes (range, 3-36 minutes).
SIG-RS for treating intracranial metastases can produce clinical outcomes comparable to those with conventional frame-based and frameless stereotactic radiosurgery techniques while providing greater patient comfort with an open-faced mask and fast treatment times.
无框架立体定向放射外科常用于治疗颅内转移瘤，但基于面罩的固定方式可能会使患者感到不适。
描述使用新型实时无框架表面成像引导放射外科（SIG-RS）技术治疗脑转移瘤的临床结果。
前瞻性收集了 44 例连续患者的数据，共 115 个颅内转移灶接受了 SIG-RS 治疗，中位数为 1 次分割（范围为 1-5 次），中位数剂量为 20 Gy（范围为 15-30 Gy）。采用 Kaplan-Meier 法估计局部控制率、区域控制率和总生存率。
所有患者的中位随访时间为 6.0 个月（范围为 0.3-21.6 个月），截至分析时，44 例患者中有 31 例（70%）死亡。35 例（80%）有随访影像学资料的患者总计 88 个病灶可评估局部控制情况。6 个月和 12 个月的局部控制率分别为 90%（95%置信区间，82-98%）和 76%（95%置信区间，60-91%）。16 例（46%）患者发生区域性失败。中位总生存时间为 7.7 个月（95%置信区间，5.7-9.7 个月）。对接受单次分割（无先前治疗）SIG-RS 治疗的 22 例患者（55 个病灶）亚组进行分析，得到了类似的临床结果。4 例患者（9%）发生 3 级或更高级别的毒性。从光束开启到光束关闭的中位治疗时间为 15 分钟（范围为 3-36 分钟）。
SIG-RS 治疗颅内转移瘤可产生与传统框架和无框架立体定向放射外科技术相当的临床结果，同时通过开放式面罩和快速治疗时间为患者提供更大的舒适度。
