Kim Kyung Hwan, Cho Byoung Chul, Lee Chang Geol, Kim Hye Ryun, Suh Yang Gun, Kim Jun Won, Choi Chihwan, Baek Jong Geal, Cho Jaeho
Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Technol Cancer Res Treat. 2016 Feb;15(1):122-9. doi: 10.1177/1533034614566993. Epub 2015 Jan 18.
In this study, the volume response and treatment outcome after hippocampus-sparing whole-brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) using tomotherapy were evaluated. Patients with primary lung adenocarcinoma and multiple brain metastases who had a Karnofsky performance status ≥ 70 and exhibited well-controlled extracranial disease were treated. The prescribed dose was administered in 10 to 14 fractions as 25 to 28 Gy to whole-brain parenchyma, as 40 to 48 Gy to the gross metastatic lesion, and as 30 to 42 Gy to a 5-mm margin to the metastatic lesion. Double-dose gadolinium contrast-enhanced magnetic resonance imaging at 1-mm slice thickness was performed before treatment and at 1, 4, and 7 months post-treatment. The tumor volume reduction ratio was calculated for each follow-up. Between July 2011 and September 2012, 11 patients with 70 lesions were included in this analysis. The median number of lesions per patient was 4 (range, 2-15). The median initial tumor volume was 0.235 cm(3) (range, 0.020-10.140 cm(3)). The treatment plans were evaluated regarding conformation number (CN), target coverage (TC), and homogeneity index (HI). The median follow-up duration was 14 months (range, 3-25 months) and the 1-year intracranial control rate was 67%. The tumor volume reduction was most prominent during the first month with a median reduction rate of 0.717 (range, -0.190 to 1.000). Complete remission was seen in 22 (33%) lesions, and 45 (64%) lesions showed more than 65% reduction in tumor volume. The CN, TC, and HI values were comparable to that of previous studies, and the mean hippocampal dose was 13.65 Gy. No treatment breaks or ≥ G3 acute toxicities were observed during or after treatment. The HS-WBRT with SIB in patients with multiple brain metastases was effective and feasible for volume reduction and showed excellent intracranial control.
在本研究中，对采用断层放疗进行同步整合加量（SIB）的海马体保留全脑放疗（HS-WBRT）后的体积反应和治疗结果进行了评估。对卡诺夫斯基功能状态≥70且颅外疾病得到良好控制的原发性肺腺癌伴多发脑转移患者进行了治疗。规定剂量分10至14次给予，全脑实质剂量为25至28 Gy，大体转移病灶剂量为40至48 Gy，转移病灶边缘5 mm范围剂量为30至42 Gy。在治疗前以及治疗后1、4和7个月进行层厚1 mm的双倍剂量钆增强磁共振成像。计算每次随访时的肿瘤体积缩小率。2011年7月至2012年9月，11例患者共70个病灶纳入本分析。每位患者病灶的中位数为4个（范围2 - 15个）。初始肿瘤体积的中位数为0.235 cm³（范围0.020 - 10.140 cm³）。对治疗计划的适形指数（CN）、靶区覆盖度（TC）和均匀性指数（HI）进行了评估。中位随访时间为14个月（范围3 - 25个月），1年颅内控制率为67%。肿瘤体积缩小在第一个月最为显著，中位缩小率为0.717（范围 - 0.190至1.000）。22个（33%）病灶完全缓解，45个（64%）病灶肿瘤体积缩小超过65%。CN、TC和HI值与既往研究相当，海马体平均剂量为13.65 Gy。治疗期间及治疗后未观察到治疗中断或≥3级急性毒性反应。对于多发脑转移患者，采用SIB的HS-WBRT在缩小体积方面有效且可行，并显示出良好的颅内控制效果。
