Yanagihara Ted K, Lee Albert, Wang Tony J C
Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
Tomography. 2017 Mar;3(1):16-22. doi: 10.18383/j.tom.2016.00268.
Brain metastases (BMs) are the most common intracranial malignancy and afflict ~10%-20% of patients with cancer. BMs tend to present at the boundaries of gray and white matter because of the distribution of small vessels. In addition, metastases may not be randomly distributed across gross anatomical regions of the brain, but this has not previously been quantified. We retrospectively analyzed a series of 28 patients with recurrent BMs with a total of 150 lesions. Each lesion was manually defined based on T1 gadolinium-enhanced imaging. Standard brain atlases were used to identify the anatomical brain region affected by each BM and the frequency of metastases in each region was compared with the expected probability, which was assumed to be a random distribution based on the brain volume. After correction for multiple comparisons, the paracingulate gyrus was found to have a statistically significant increase ( = 4.731 × 10) in the rate of BMs relative to the random spatial distribution. A nonstochastic spatial distribution of metastases may be used to guide partial brain radiotherapy with risk-adapted dose delivery and reduce the risk of neurotoxicity due to overtreatment.
脑转移瘤（BMs）是最常见的颅内恶性肿瘤，约10%-20%的癌症患者会受到影响。由于小血管的分布，脑转移瘤往往出现在灰质和白质的边界处。此外，转移瘤可能并非随机分布于脑的大体解剖区域，但此前尚未对此进行量化。我们回顾性分析了28例复发性脑转移瘤患者，共150个病灶。每个病灶均基于钆增强T1成像手动定义。使用标准脑图谱来确定每个脑转移瘤所累及的解剖脑区，并将每个区域转移瘤的发生频率与预期概率进行比较，预期概率假定基于脑体积呈随机分布。在对多重比较进行校正后，发现相对于随机空间分布，扣带旁回的脑转移瘤发生率有统计学显著增加（= 4.731 × 10）。转移瘤的非随机空间分布可用于指导采用风险适应性剂量递送的局部脑放疗，并降低因过度治疗导致神经毒性的风险。
