Jensen Garrett L, Wu Haijun, Luo Dershan, Ho Jennifer C, Allen Pamela K, Briere Tina M, Brown Paul D, Li Jing
Department of Radiation Oncology, Baylor Scott & White, Temple, Texas, USA.
Head and Neck Malignancies Section, Department of Radiation Oncology, Xiangya Hospital, Central South University, Hunan Province, China.
J Radiosurg SBRT. 2019;6(3):209-216.
We present our institutional experience in treating brain metastases with GK-SRS and a headframe fixed to the skull with only 3 pins to avoid collisions between the headframe and the Gamma Knife (GK) machine.
Among 3500 consecutive patients who received GK-SRS in 2011-2017, 50 had 1 of the 2 anterior pins removed immediately before treatment of ≥1 brain lesion. Endpoints were local control, dosimetric parameters, and toxicity.
Median follow-up time for the 49 patients with follow-up was 7.0 months (range 0.2-57.0). Median number of lesions treated per session was 6 (range 1-18); a median 1 lesion was treated with 3-pin fixation (range 1-2) and a median 5 lesions treated with 4-pin fixation (range 0-17) during the same session. Lesions treated with 3-pin fixation were in the occipital lobe (n=41), cerebellum (n=9), or temporal lobe (n=1). No local failures were noted. The sole grade 2 toxicity (partial seizure) was attributed to treatment of a 4-pin-fixed lesion. Except for gradient index, dosimetry did not vary for lesions treated with 3-pin versus 4-pin fixation.
Treating brain metastases with 3-pin fixation did not compromise treatment outcome and is a good option for posterior brain metastases that cannot otherwise be treated with 4-pin GK-SRS.
我们介绍了我们机构使用伽玛刀立体定向放射治疗（GK-SRS）以及仅用3根针固定在颅骨上的头架来治疗脑转移瘤的经验，以避免头架与伽玛刀（GK）机器发生碰撞。
在2011年至2017年连续接受GK-SRS治疗的3500例患者中，有50例在治疗≥1个脑病变之前立即移除了2根前针中的1根。观察终点为局部控制、剂量学参数和毒性。
49例有随访的患者的中位随访时间为7.0个月（范围0.2 - 57.0个月）。每次治疗的病变中位数为6个（范围1 - 18个）；在同一次治疗中，用3根针固定治疗的病变中位数为1个（范围1 - 2个），用4根针固定治疗的病变中位数为5个（范围0 - 17个）。用3根针固定治疗的病变位于枕叶（n = 41）、小脑（n = 9）或颞叶（n = 1）。未观察到局部失败。唯一的2级毒性（部分性癫痫发作）归因于对一个用4根针固定的病变的治疗。除梯度指数外，用3根针与4根针固定治疗的病变的剂量学没有差异。
用3根针固定治疗脑转移瘤不会影响治疗结果，对于无法用4根针GK-SRS治疗的后脑转移瘤是一个不错的选择。
