Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Department of Radiation Oncology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
J Radiat Res. 2020 Jul 6;61(4):546-553. doi: 10.1093/jrr/rraa038.
The aim of this study was to assess clinical outcomes using linac-based, fractionated, stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for large brain metastasis (LBM) unsuitable for surgical resection. Between January 2009 and October 2018 we treated 21 patients with LBM using linac-based fSRT. LBM was defined as a tumor with ≥30 mm maximal diameter in gadolinium-enhanced magnetic resonance images. LBMs originated from the lung (n = 17, 81%), ovary (n = 2, 9.5%), rectum (n = 1, 4.8%) and esophagus (n = 1, 4.8%). The median pretreatment Karnofsky performance status was 50 (range: 50-80). Recursive partition analysis (RPA) was as follows: Classes 2 and 3 were 7 and 14 patients, respectively. The median follow-up was 5 months (range: 1-86 months). The range of tumor volume was 8.7-26.5 cm3 (median: 17.1 cm3). All patients were basically treated with 35Gy in 5 fractions, except in three cases. The progression-free survival was 3.0 months. The median survival time was 7.0 months. There was no permanent radiation injury in any of the patients. Radiation-caused central nervous system necrosis, according to the Common Terminology Criteria for Adverse Events version 4.0, occurred in one patient (grade 3). One patients received bevacizumab for radiation necrosis. Two patients underwent additional surgical resection due to local progression and cyst formation. For patients with LBM unsuitable for surgical resection, linac-based fSRT is a promising therapeutic alternative.
本研究旨在评估使用适形调强放射治疗（fSRT）治疗不适合手术切除的大脑转移瘤（LBM）的临床结果。我们在 2009 年 1 月至 2018 年 10 月期间，对 21 例 LBM 患者采用基于直线加速器的 fSRT 治疗。LBM 定义为增强磁共振成像中最大直径≥30mm 的肿瘤。LBM 来源于肺（n=17，81%）、卵巢（n=2，9.5%）、直肠（n=1，4.8%）和食管（n=1，4.8%）。治疗前的卡氏功能状态评分为 50（范围：50-80）。递归分区分析（RPA）结果如下：2 类和 3 类患者分别为 7 例和 14 例。中位随访时间为 5 个月（范围：1-86 个月）。肿瘤体积范围为 8.7-26.5cm3（中位数：17.1cm3）。除 3 例外，所有患者均基本接受 35Gy/5f 的治疗方案。无进展生存期为 3.0 个月。中位总生存期为 7.0 个月。无患者出现永久性放射性损伤。根据不良事件通用术语标准 4.0，1 例患者出现放射性中枢神经系统坏死（3 级）。1 例患者因放射性坏死接受贝伐珠单抗治疗。2 例患者因局部进展和囊肿形成接受了额外的手术切除。对于不适合手术切除的 LBM 患者，基于直线加速器的 fSRT 是一种很有前途的治疗选择。
