立体定向放射外科治疗切除后的脑转移瘤：空洞动力学及影响其演变的因素
Stereotactic radiosurgery for resected brain metastasis: Cavity dynamics and factors affecting its evolution.
作者信息
Alghamdi Majed, Hasan Yaser, Ruschin Mark, Atenafu Eshetu G, Myrehaug Sten, Tseng Chia-Lin, Spears Julian, Mainprize Todd, Sahgal Arjun, Soliman Hany
机构信息
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Department of Medicine, Al Baha University, Al Baha, Saudi Arabia.
出版信息
J Radiosurg SBRT. 2018;5(3):191-200.
OBJECTIVE
To determine changes in post-surgical cavity volume for metastases based on time from surgery, pre-operative tumor dimensions and other predictors, in patients planned for post-operative stereotactic radiosurgery (SRS).
METHODS
Patients with resected brain metastases from a primary solid tumor, treated with post-operative surgical cavity SRS from 2008 to 2014 were identified from an institutional prospective database. The segmented three-dimensional (3D) volume of the pre-operative tumor and post-operative surgical cavity were determined based on MRI and percent volume change was calculated. Patients were grouped according to early (<21 days), intermediate (22-42 days), and late (>42 days) intervals based on the number of days between the date of surgery and the treatment planning MRI. Potential predictive factors including tumor size, location, age, dural involvement, and degree of surgical resection were also analyzed.
RESULTS
Sixty-one cavities in 59 patients were evaluated. Overall, a significant volume reduction (4cm, p=0.03) was observed comparing tumor and cavity volumes. For larger tumors, an average volume reduction of 11.6% (p=0.01) was observed compared to an increase of 34.4% in smaller tumors (p=0.69). For both large and small tumors, cavities were larger in the early interval especially for smaller tumors. During the intermediate interval, a significant volume reduction was observed for larger tumors (28%, p=0.0007). Tumor size, dural involvement, age and time from surgery were significant predictors for volume change on univariate analysis. On multivariate analysis, tumor size, dural involvement and time from surgery were significant.
CONCLUSION
Tumor size (>3cm), dural involvement and longer time from surgery were significant predictors of cavity volume reduction. Caution must be taken when treating cavities in the early (<21 days) interval after surgery as it may lead to irradiating more normal tissue especially in small tumors.
目的
在计划接受术后立体定向放射外科治疗（SRS）的患者中，根据手术时间、术前肿瘤大小及其他预测因素，确定转移瘤术后腔隙体积的变化。
方法
从一个机构前瞻性数据库中识别出2008年至2014年接受原发性实体瘤切除术后脑转移瘤且接受术后手术腔隙SRS治疗的患者。根据磁共振成像（MRI）确定术前肿瘤和术后手术腔隙的三维（3D）分割体积，并计算体积变化百分比。根据手术日期与治疗计划MRI之间的天数，将患者分为早期（<21天）、中期（22 - 42天）和晚期（>42天）组。还分析了包括肿瘤大小、位置、年龄、硬脑膜受累情况和手术切除程度等潜在预测因素。
结果
对59例患者的61个腔隙进行了评估。总体而言，比较肿瘤和腔隙体积时观察到显著的体积减小（4cm，p = 0.03）。对于较大肿瘤，平均体积减小11.6%（p = 0.01），而较小肿瘤体积增加34.4%（p = 0.69）。对于大、小肿瘤，早期腔隙都较大，尤其是较小肿瘤。在中期，较大肿瘤体积显著减小（28%，p = 0.0007）。单因素分析中，肿瘤大小、硬脑膜受累情况、年龄和手术时间是体积变化的显著预测因素。多因素分析中，肿瘤大小、硬脑膜受累情况和手术时间具有显著性。
结论
肿瘤大小（>3cm）、硬脑膜受累情况和较长的手术时间是腔隙体积减小的显著预测因素。术后早期（<21天）治疗腔隙时必须谨慎，因为这可能导致照射更多正常组织，尤其是在小肿瘤中。
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