Vrána David, Študentová Hana, Matzenauer Marcel, Vlachová Zuzana, Cwiertka Karel, Gremlica David, Kalita Ondřej
Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic; Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, University Hospital in Olomouc, Olomouc 77900, Czech Republic; Toxicogenomics Unit, National Institute of Public Health, Prague 10042, Czech Republic.
Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic.
Oncol Lett. 2016 Jun;11(6):3777-3781. doi: 10.3892/ol.2016.4440. Epub 2016 Apr 15.
Renal cell cancer patients with brain metastatic disease generally have poor prognosis. Treatment options include surgery, radiotherapy, targeted therapy or best supportive care with respect to disease burden, patient preference and performance status. In the present case report the radiotherapy technique combining whole brain radiotherapy with hippocampal sparing (hippocampal avoidance whole brain radiotherapy HA-WBRT) and hypofractionated stereotactic radiotherapy (SRT) of the brain metastases is performed in a patient with metastatic renal cell carcinoma. HA-WBRT was administered to 30 Gy in 10 fractions with sparing of the hippocampal structures and SRT of 21 Gy in 3 fractions to brain metastases which has preceded the HA-WBRT. Two single arc volumetric modulated arc radiotherapy (VMAT) plans were prepared using Monaco planning software. The HA-WBRT treatment plan achieved the following results: D2=33.91 Gy, D98=25.20 Gy, D100=14.18 Gy, D50=31.26 Gy. The homogeneity index was calculated as a deduction of the minimum dose in 2% and 98% of the planning target volume (PTV), divided by the minimum dose in 50% of the PTV. The maximum dose to the hippocampus was 17.50 Gy and mean dose was 11.59 Gy. The following doses to organs at risk (OAR) were achieved: Right opticus Dmax, 31.96 Gy; left opticus Dmax, 30.96 Gy; chiasma D max, 32,76 Gy. The volume of PTV for stereotactic radiotherapy was 3,736 cm3, with coverage D100=20.95 Gy and with only 0.11% of the PTV being irradiated to dose below the prescribed dose. HA-WBRT with SRT represents a feasible technique for radiotherapy of brain metastatic disease, however this technique is considerably demanding on departmental equipment and staff time/experience.
患有脑转移疾病的肾细胞癌患者通常预后较差。治疗选择包括手术、放疗、靶向治疗或根据疾病负担、患者偏好和身体状况进行最佳支持治疗。在本病例报告中，对一名转移性肾细胞癌患者实施了将全脑放疗与海马体保护（海马体避让全脑放疗HA-WBRT）以及脑转移瘤的低分割立体定向放疗（SRT）相结合的放疗技术。HA-WBRT以10次分割给予30 Gy，同时保护海马体结构，在HA-WBRT之前对脑转移瘤进行3次分割、每次7 Gy的SRT。使用Monaco治疗计划软件准备了两个单弧容积调强弧形放疗（VMAT）计划。HA-WBRT治疗计划取得了以下结果：D2 = 33.91 Gy，D98 = 25.20 Gy，D100 = 14.18 Gy，D50 = 31.26 Gy。均匀性指数通过规划靶区（PTV）2%和98%处的最小剂量之差除以PTV 50%处的最小剂量来计算。海马体的最大剂量为17.50 Gy，平均剂量为11.59 Gy。对危及器官（OAR）实现了以下剂量：右侧视神经Dmax为31.96 Gy；左侧视神经Dmax为30.96 Gy；视交叉Dmax为32.76 Gy。立体定向放疗的PTV体积为3736 cm³，覆盖D100 = 20.95 Gy，且只有0.11%的PTV受到低于规定剂量的照射。HA-WBRT联合SRT是一种可行的脑转移疾病放疗技术，然而该技术对科室设备以及工作人员的时间/经验要求相当高。
