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挽救性立体定向放射外科治疗多发性脑复发：多少剂量才足够？

Salvage Stereotactic Radiosurgery for Multiple Brain Recurrences: How Much is Enough?

作者信息

Hsu Fred

机构信息

Radiation Oncology, BC Cancer Agency - Abbotsford Centre.

出版信息

Cureus. 2017 Nov 10;9(11):e1835. doi: 10.7759/cureus.1835.

DOI:10.7759/cureus.1835
PMID:29333357
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5760112/
Abstract

Stereotactic radiosurgery (SRS) can be used as a salvage treatment in selected patients with recurrent brain metastases after previous brain radiation. We report the case of a patient with metastatic lung adenocarcinoma who experienced recurrence numerous times in the brain and was successfully treated each time with SRS. For this patient, brain imaging surveillance helped identify metastases early for salvage SRS. We have also included a discussion of published literature regarding the neurocognitive toxicity of repeated courses of SRS.

摘要

立体定向放射外科（SRS）可用于先前脑部放疗后复发性脑转移瘤的特定患者的挽救性治疗。我们报告了一例转移性肺腺癌患者，其脑部多次复发，每次均通过SRS成功治疗。对于该患者，脑部影像监测有助于早期发现转移瘤以便进行挽救性SRS治疗。我们还纳入了关于重复疗程SRS的神经认知毒性的已发表文献的讨论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70fb/5760112/117e274eb9af/cureus-0009-00000001835-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70fb/5760112/b71561f407e0/cureus-0009-00000001835-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70fb/5760112/117e274eb9af/cureus-0009-00000001835-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70fb/5760112/b71561f407e0/cureus-0009-00000001835-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70fb/5760112/117e274eb9af/cureus-0009-00000001835-i02.jpg

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本文引用的文献

1
A Multi-institutional Prospective Observational Study of Stereotactic Radiosurgery for Patients With Multiple Brain Metastases (JLGK0901 Study Update): Irradiation-related Complications and Long-term Maintenance of Mini-Mental State Examination Scores.一项多机构对多发脑转移瘤患者进行立体定向放射外科治疗的前瞻性观察研究（JLGK0901研究更新）：放疗相关并发症及简易精神状态检查表评分的长期维持情况
Int J Radiat Oncol Biol Phys. 2017 Sep 1;99(1):31-40. doi: 10.1016/j.ijrobp.2017.04.037. Epub 2017 Aug 7.
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Evaluating Critical Brain Radiation Doses in the Treatment of Multiple Brain Lesions with Gamma Knife Radiosurgery.评估伽玛刀放射外科治疗多发性脑病变时的关键脑辐射剂量
Stereotact Funct Neurosurg. 2017;95(4):268-278. doi: 10.1159/000478272. Epub 2017 Aug 16.
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The strategy of repeat stereotactic radiosurgery without whole brain radiation treatment for new brain metastases: Outcomes and implications for follow-up monitoring.针对新发脑转移瘤不进行全脑放疗而采用重复立体定向放射外科治疗的策略：结果及对后续监测的意义。
Pract Radiat Oncol. 2016 Nov-Dec;6(6):409-416. doi: 10.1016/j.prro.2016.04.004. Epub 2016 Apr 26.
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Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial.单纯放射外科治疗与放射外科联合全脑放射治疗对1至3个脑转移瘤患者认知功能的影响：一项随机临床试验。
JAMA. 2016 Jul 26;316(4):401-409. doi: 10.1001/jama.2016.9839.
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Discordance of Mutation Statuses of Epidermal Growth Factor Receptor and K-ras between Primary Adenocarcinoma of Lung and Brain Metastasis.肺原发性腺癌与脑转移瘤中表皮生长因子受体和K-ras突变状态的不一致性
Int J Mol Sci. 2016 Apr 7;17(4):524. doi: 10.3390/ijms17040524.
6
Repeat Courses of Stereotactic Radiosurgery (SRS), Deferring Whole-Brain Irradiation, for New Brain Metastases After Initial SRS.对初始 SRS 后新出现的脑转移瘤重复行立体定向放射外科（SRS）治疗，推迟全脑放疗。
Int J Radiat Oncol Biol Phys. 2015 Aug 1;92(5):993-999. doi: 10.1016/j.ijrobp.2015.04.036. Epub 2015 Apr 28.
7
Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial.接受放射外科手术或放射外科手术加全脑照射治疗的脑转移瘤患者的神经认知：一项随机对照试验。
Lancet Oncol. 2009 Nov;10(11):1037-44. doi: 10.1016/S1470-2045(09)70263-3. Epub 2009 Oct 2.
8
Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.立体定向放射外科联合全脑放射治疗与单纯立体定向放射外科治疗脑转移瘤的随机对照试验
JAMA. 2006 Jun 7;295(21):2483-91. doi: 10.1001/jama.295.21.2483.