导航经颅磁刺激运动功能区定位在幕上脑转移瘤患者辅助放疗计划中的作用
The Role of Navigated Transcranial Magnetic Stimulation Motor Mapping in Adjuvant Radiotherapy Planning in Patients With Supratentorial Brain Metastases.
作者信息
Schwendner Maximilian J, Sollmann Nico, Diehl Christian D, Oechsner Markus, Meyer Bernhard, Krieg Sandro M, Combs Stephanie E
机构信息
Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
出版信息
Front Oncol. 2018 Oct 2;8:424. doi: 10.3389/fonc.2018.00424. eCollection 2018.
In radiotherapy (RT) of brain tumors, the primary motor cortex is not regularly considered in target volume delineation, although decline in motor function is possible due to radiation. Non-invasive identification of motor-eloquent brain areas is currently mostly restricted to functional magnetic resonance imaging (fMRI), which has shown to lack precision for this purpose. Navigated transcranial magnetic stimulation (nTMS) is a novel tool to identify motor-eloquent brain areas. This study aims to integrate nTMS motor maps in RT planning and evaluates the influence on dosage modulations in patients harboring brain metastases. Preoperative nTMS motor maps of 30 patients diagnosed with motor-eloquent brain metastases were fused with conventional planning imaging and transferred to the RT planning software. RT plans of eleven patients were optimized by contouring nTMS motor maps as organs at risk (OARs). Dose modulation analyses were performed using dose-volume histogram (DVH) parameters. By constraining the dose applied to the nTMS motor maps outside the planning target volume (PTV) to 15 Gy, the mean dose (Dmean) to the nTMS motor maps was significantly reduced by 18.1% from 23.0 Gy (16.9-30.4 Gy) to 18.9 Gy (13.5-28.8 Gy, < 0.05). The Dmean of the PTV increased by 0.6 ± 0.3 Gy (1.7%). Implementing nTMS motor maps in standard RT planning is feasible in patients suffering from intracranial metastases. A significant reduction of the dose applied to the nTMS motor maps can be achieved without impairing treatment doses to the PTV. Thus, nTMS might provide a valuable tool for safer application of RT in patients harboring motor-eloquent brain metastases.
在脑肿瘤的放射治疗(RT)中,尽管放疗可能导致运动功能下降,但在靶区勾画时通常不会常规考虑初级运动皮层。目前,运动功能区脑区的非侵入性识别大多局限于功能磁共振成像(fMRI),而事实证明,fMRI在这方面缺乏精准度。导航经颅磁刺激(nTMS)是一种识别运动功能区脑区的新型工具。本研究旨在将nTMS运动图谱整合到放疗计划中,并评估其对脑转移瘤患者剂量调整的影响。对30例被诊断为运动功能区脑转移瘤的患者进行术前nTMS运动图谱检查,并将其与传统的计划成像融合,然后传输到放疗计划软件中。通过将nTMS运动图谱勾勒为危及器官(OARs),对11例患者的放疗计划进行了优化。使用剂量体积直方图(DVH)参数进行剂量调整分析。通过将计划靶区(PTV)外应用于nTMS运动图谱的剂量限制在15 Gy,nTMS运动图谱的平均剂量(Dmean)从23.0 Gy(16.9 - 30.4 Gy)显著降低18.1%至18.9 Gy(13.5 - 28.8 Gy,<0.05)。PTV的Dmean增加了0.6±0.3 Gy(1.7%)。在患有颅内转移瘤的患者中,将nTMS运动图谱应用于标准放疗计划是可行的。在不影响PTV治疗剂量的情况下,可以显著降低应用于nTMS运动图谱的剂量。因此,nTMS可能为更安全地对运动功能区脑转移瘤患者进行放疗提供一种有价值的工具。