Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Hawksbury Road, Westmead, Australia; Institute of Medical Physics, The University of Sydney, New South Wales, Australia; Sydney West Radiation Oncology Network, Sydney, Australia; Sydney West Translational Cancer Research Centre, Hawksbury Road, Westmead, Australia; School of Medicine, The University of Sydney, New South Wales, Australia.
Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Hawksbury Road, Westmead, Australia; Sydney West Radiation Oncology Network, Sydney, Australia; Sydney West Translational Cancer Research Centre, Hawksbury Road, Westmead, Australia; School of Medicine, The University of Sydney, New South Wales, Australia.
Int J Radiat Oncol Biol Phys. 2018 Nov 15;102(4):727-733. doi: 10.1016/j.ijrobp.2018.06.021. Epub 2018 Jun 25.
To determine whether there are any changes in brain metastases or resection cavity volumes between planning magnetic resonance imaging (MRI) and radiosurgery (RS) treatment and whether these led to a change in management or alteration in the RS plan.
Patients undergoing RS for brain metastasis or tumor resection cavities had a standardized planning MRI (MRI-1) performed and a repeat verification MRI (MRI-2) 24 hours before RS. Any change in management, including replanning based on MRI-2, was recorded.
Thirty-four patients with a total of 59 lesions (44 metastases and 15 tumor resection cavities) were assessed with a median time between MRI-1 and MRI-2 of 7 days. Seventeen patients (50%) required a change in management based on the changes seen on MRI-2. For patients with 7 days or less between scans, 41% (9 of 22) required a change in management; among patients with 8 days or more between scans, 78% (7 of 9) required a change in management. Per lesion, 32 out of 59 lesions required replanning, including 7 of 15 (47%) cavities and 25 of 44 (57%) metastases, with the most common reason (23 lesions) being an increase in gross target volume (tumor) or clinical target volume (tumor cavity).
Measurable changes occur in brain metastasis over a short amount of time, with a change in management required in 41% of patients with 7 days between MRI-1 and MRI-2 and in 78% of patients when there is a delay longer than 7 days. We therefore recommend that the time between planning MRI and RS treatment be as short as possible.
确定在计划磁共振成像（MRI）和放射外科（RS）治疗之间脑转移瘤或切除腔的体积是否有变化，以及这些变化是否导致治疗管理的改变或 RS 计划的改变。
对接受脑转移瘤或肿瘤切除腔 RS 治疗的患者进行标准的计划 MRI（MRI-1）检查，并在 RS 治疗前 24 小时进行重复验证 MRI（MRI-2）。记录任何管理上的变化，包括基于 MRI-2 进行重新计划。
34 名患者共 59 个病灶（44 个转移瘤和 15 个肿瘤切除腔）进行了评估，MRI-1 和 MRI-2 之间的中位时间为 7 天。17 名患者（50%）需要根据 MRI-2 上的变化改变管理。对于扫描时间在 7 天以内的患者，41%（22 例中有 9 例）需要改变管理；扫描时间在 8 天或以上的患者中，78%（9 例中有 7 例）需要改变管理。59 个病灶中有 32 个需要重新计划，包括 15 个腔中的 7 个（47%）和 44 个转移瘤中的 25 个（57%），最常见的原因（23 个病灶）是肿瘤的大体肿瘤体积（GTV）或临床靶体积（CTV）增加。
脑转移瘤在短时间内会发生可测量的变化，在 MRI-1 和 MRI-2 之间间隔 7 天的患者中有 41%需要改变管理，间隔超过 7 天的患者中有 78%需要改变管理。因此，我们建议计划 MRI 和 RS 治疗之间的时间尽可能短。
