Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2019 Feb 12;34(8):e57. doi: 10.3346/jkms.2019.34.e57. eCollection 2019 Mar 4.
Recently, a new generation of gamma knife radiosurgery (GKRS) equipped with a frameless immobilization system has encouraged the use of fractionated GKRS as an increasingly favorable treatment option. We investigated the preliminary outcome of efficacy and toxicity associated with frameless fractionated gamma knife radiosurgery (FF GKRS) for the treatment of large metastatic brain tumors.
Fifteen patients with 17 lesions were treated using FF GKRS and included in this study, because of the large tumor size of more than 10 cm. FF GKRS was performed based on a thermoplastic mask system for 3 to 5 consecutive days.
The mean duration of clinical follow-up was 12 months (range, 4-24), and the local control rate was 100%. Tumor volume decreased in 13 lesions (76.5%), and remained stable in 4 lesions (23.5%). One patient was classified as new lesion development because of the occurrence of leptomeningeal seeding regardless of the tumor volume change. Compared with the initial volume at the time of FF GKRS, tumor volume change at the last follow-up was 62.32% ± 29.80%. Cumulative survival rate at 12 months was 93.3% ± 6.4%. One patient died during the follow-up period because of the progression of the primary disease. No patient showed radiation necrosis on the follow-up images.
Daily FF GKRS by gamma knife ICON™ revealed satisfactory tumor control rate and low morbidity, despite the short follow-up period. Further prospective studies and a longer follow-up of a large cohort of patients diagnosed with brain metastases are required to elucidate the effect of FF GKRS in brain metastases.
最近，新一代无框架定位系统的伽玛刀放射外科（GKRS）鼓励采用分次 GKRS 作为一种越来越有优势的治疗选择。我们研究了无框架分次伽玛刀放射外科（FF GKRS）治疗大型脑转移瘤的疗效和毒性的初步结果。
本研究纳入了 15 例 17 个病灶的患者，由于肿瘤直径大于 10cm，采用 FF GKRS 治疗。FF GKRS 基于热塑面具系统进行 3-5 天的连续治疗。
平均临床随访时间为 12 个月（范围：4-24），局部控制率为 100%。13 个病灶肿瘤体积缩小（76.5%），4 个病灶肿瘤体积稳定（23.5%）。1 例患者因发生软脑膜播散，即使肿瘤体积无变化，也被归类为新发病灶。与 FF GKRS 时的初始体积相比，最后一次随访时肿瘤体积变化为 62.32%±29.80%。12 个月的累积生存率为 93.3%±6.4%。1 例患者在随访期间因原发疾病进展而死亡。在随访图像上没有患者出现放射性坏死。
尽管随访时间较短，但使用伽玛刀 ICON™进行每日 FF GKRS 显示出令人满意的肿瘤控制率和低发病率。需要进一步的前瞻性研究和对大量脑转移瘤患者的更长随访时间，以阐明 FF GKRS 在脑转移瘤中的效果。
