伽玛刀立体定向放射外科治疗肾细胞癌和黑色素瘤脑转移瘤——剂量反应比较
Gamma knife stereotactic radiosurgery for renal cell carcinoma and melanoma brain metastases-comparison of dose response.
作者信息
Lin Hong-Yiou, Watanabe Yoichi, Cho L Chinsoo, Yuan Jianling, Hunt Matthew A, Sperduto Paul W, Abosch Aviva, Watts Charles R, Lee Chung K
机构信息
Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
出版信息
J Radiosurg SBRT. 2013;2(3):193-207.
BACKGROUND
Metastatic melanoma appears to have inferior local control (LC) than renal cell carcinoma (RCC) after stereotactic radiosurgery (SRS) to the brain.
OBJECTIVE
To retrospectively examine RCC vs. melanoma LC dose response.
METHODS
Follow-up data were available for 88 patients (RCC=38; melanoma=50) with 235 tumors (RCC=92; melanoma=143) treated with Gamma Knife SRS between Dec. 2005 to Aug. 2012. LC was compared among RCC vs. melanoma and then at each margin dose (≤18Gy, 20Gy, 22Gy, and 24Gy). Patient survival and toxicity were analyzed. Median follow-up was 9.8 months (RCC) and 5.4 months (melanoma).
RESULTS
Patient characteristics were similar between RCC vs. melanoma with respect to gender, age, KPS, GPA, lesions per patient, and tumor volume. For all margin doses, LC at 6 months was 98.6% (RCC) vs. 79.2% (melanoma). When broken down by margin dose, at ≤18 Gy (P<0.0001) and 20 Gy (P=0.02), RCC had better LC compared to melanoma. At 22 Gy, LC were similar between the two histologies (P=0.19). At 24 Gy, melanoma had better LC than RCC (P=0.02). Tumor volumes were similar between RCC vs. melanoma at each margin dose (P>0.05). Small melanoma tumors (<4ml) exhibited LC dose dependence. Median survival was 16.1 months (RCC) and 9.6 months (melanoma). Toxicity was not significantly different between the two histologies and margin doses.
CONCLUSIONS
RCC has significantly better LC than melanoma after SRS. Higher doses could be used for melanoma tumors <4ml to improve melanoma LC.
背景
立体定向放射外科治疗（SRS）后，转移性黑色素瘤的局部控制（LC）似乎比肾细胞癌（RCC）差。
目的
回顾性研究肾细胞癌与黑色素瘤的局部控制剂量反应。
方法
2005年12月至2012年8月期间，对88例患者（肾细胞癌=38例；黑色素瘤=50例）的235个肿瘤（肾细胞癌=92个；黑色素瘤=143个）进行伽玛刀SRS治疗，获得随访数据。比较肾细胞癌与黑色素瘤之间的局部控制情况，然后比较每个边缘剂量（≤18Gy、20Gy、22Gy和24Gy）下的局部控制情况。分析患者生存率和毒性。中位随访时间为9.8个月（肾细胞癌）和5.4个月（黑色素瘤）。
结果
肾细胞癌与黑色素瘤在性别、年龄、KPS、GPA、每位患者的病灶数和肿瘤体积方面的患者特征相似。对于所有边缘剂量，6个月时的局部控制率肾细胞癌为98.6%，黑色素瘤为79.2%。按边缘剂量细分时，在≤18Gy（P<0.0001）和20Gy（P=0.02）时，肾细胞癌的局部控制优于黑色素瘤。在22Gy时，两种组织学类型的局部控制相似（P=0.19）。在24Gy时，黑色素瘤的局部控制优于肾细胞癌（P=0.02）。在每个边缘剂量下，肾细胞癌与黑色素瘤的肿瘤体积相似（P>0.05）。小的黑色素瘤肿瘤（<4ml）表现出局部控制剂量依赖性。中位生存期肾细胞癌为16.1个月，黑色素瘤为9.6个月。两种组织学类型和边缘剂量之间的毒性无显著差异。
结论
立体定向放射外科治疗后，肾细胞癌的局部控制明显优于黑色素瘤。对于<4ml的黑色素瘤肿瘤，可使用更高剂量以改善黑色素瘤的局部控制。
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