Nanda Ronica, Dhabbaan Anees, Janss Anna, Shu Hui-Kuo, Esiashvili Natia
Departments of Radiation Oncology, Winship Cancer Institute at Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA.
J Neurooncol. 2014 Apr;117(2):329-35. doi: 10.1007/s11060-014-1392-7. Epub 2014 Feb 19.
Recurrent malignant primary and metastatic central nervous system (CNS) tumors in pediatric patients are devastating, and efforts to improve outcomes for these patients have been disappointing. Conventional re-irradiation in these patients increases the risk of significant toxicity. We therefore evaluated feasibility and outcomes using frameless radiosurgery (FRS) in children with recurrent primary and metastatic brain tumors. We reviewed five cases of recurrent primary and metastatic brain tumors treated with frameless radiosurgery between 2008 and 2013. We analyzed safety and feasibility, dosimetric data, local control, and adverse effects. Five patients were treated with frameless radiosurgery for palliation. Fifteen target volumes were treated using our institutional FRS system. The volumes of targets ranged from 0.08 to 51.67 cm(3) with doses ranging from 15 to 21 Gy. Radiosurgery was well tolerated, decreased the need for large-volume CNS irradiation, and allowed for effective palliation in this small cohort. Frameless radiosurgery is feasible in this patient population. Frameless radiosurgery should be considered in management of select patients with recurrent primary or metastatic brain tumors.
小儿复发性恶性原发性和转移性中枢神经系统（CNS）肿瘤具有毁灭性，而改善这些患者治疗结果的努力一直令人失望。对这些患者进行传统的再照射会增加严重毒性的风险。因此，我们评估了在患有复发性原发性和转移性脑肿瘤的儿童中使用无框架放射外科（FRS）的可行性和治疗结果。我们回顾了2008年至2013年间接受无框架放射外科治疗的5例复发性原发性和转移性脑肿瘤病例。我们分析了安全性和可行性、剂量学数据、局部控制情况及不良反应。5例患者接受了无框架放射外科治疗以缓解症状。使用我们机构的FRS系统对15个靶区进行了治疗。靶区体积范围为0.08至51.67 cm³，剂量范围为15至21 Gy。放射外科耐受性良好，减少了对大体积中枢神经系统照射的需求，并在这个小队列中实现了有效的姑息治疗。无框架放射外科在该患者群体中是可行的。对于部分复发性原发性或转移性脑肿瘤患者的管理，应考虑无框架放射外科。
