脑转移瘤伽玛刀治疗中面罩固定与框架固定的前瞻性评估。
Prospective assessment of mask versus frame fixation during Gamma Knife treatment for brain metastases.
机构信息
Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany.
Department of Radiation Oncology, University Medical Center Mannheim, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany; University Medical Center Freiburg, Germany.
出版信息
Radiother Oncol. 2020 Jun;147:195-199. doi: 10.1016/j.radonc.2020.05.011. Epub 2020 May 19.
PURPOSE
The newest generation of the Leksell Gamma Knife (GK) allows frame based as well as frameless treatment. We here report outcomes of a prospective non-randomized study on mask fixation (MF) versus frame fixation (FF) for GK treatment of brain metastases.
METHODS
The decision for FF or MF was made on a case-by-case basis. Factors considered were patients' preference, proximity of critical structures, V and treatment time. Either stereotactic radiosurgery or fractionated stereotactic radiotherapy in up to 3 fractions was performed. For MF, a PTV margin of 1 mm was added. Follow-up included quarterly MRI scans. The primary outcome was local control. Secondary endpoints were progression-free survival (PFS), overall survival (OS) and the incidence of radionecrosis.
RESULTS
A total of 197 lesions (169 FF and 28 MF) were treated in 76 patients (59 FF and 17 MF). 187 lesions were treated with SRS and 10 with FSRT. Median dose was 22 Gy in both groups and median follow-up was 9.3 months. There was a higher local failure rate (HR: 3.69; 95%CI: 1.13-12.0; p = 0.03) with 11 local failures in the FF and none in the MF cohort. No differences were observed between the groups for OS (median: n.r. vs. 16.9 months; HR:1.00; 95%CI: 0.41-2.46; p = 0.999) and PFS (median: 6.9 vs. 8.4 months; HR: 0.92; 95%CI: 0.47-1.79; p = 0.800). Three cases of radionecrosis occurred with FF but none with MF (p = 0.67).
CONCLUSIONS
Gamma Knife treatment with MF does not result in worse outcome or increased rates of radionecrosis in this non-randomized study.
目的
最新一代的 Leksell Gamma Knife（GK）允许基于框架和无框架治疗。我们在此报告一项关于GK 治疗脑转移瘤时使用面罩固定（MF）与框架固定（FF）的前瞻性非随机研究结果。
方法
根据具体情况决定使用 FF 或 MF。考虑的因素包括患者的偏好、关键结构的接近程度、V 因子和治疗时间。采用立体定向放射外科或最多 3 个分次的立体定向放疗。对于 MF，添加了 1mm 的 PTV 边界。随访包括每季度进行 MRI 扫描。主要结果是局部控制。次要终点是无进展生存期（PFS）、总生存期（OS）和放射性坏死的发生率。
结果
在 76 名患者（59 名 FF 和 17 名 MF）中治疗了 197 个病灶（169 个 FF 和 28 个 MF）。187 个病灶采用 SRS 治疗，10 个病灶采用 FSRT 治疗。两组的中位剂量均为 22Gy，中位随访时间为 9.3 个月。FF 组的局部失败率较高（HR：3.69；95%CI：1.13-12.0；p=0.03），有 11 个局部失败，而 MF 组没有。两组之间的 OS（中位：未达到 vs. 16.9 个月；HR：1.00；95%CI：0.41-2.46；p=0.999）和 PFS（中位：6.9 vs. 8.4 个月；HR：0.92；95%CI：0.47-1.79；p=0.800）均无差异。FF 组发生 3 例放射性坏死，而 MF 组无放射性坏死（p=0.67）。
结论
在这项非随机研究中，使用 MF 的 Gamma Knife 治疗不会导致更差的结果或增加放射性坏死的发生率。
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