两阶段立体定向放射外科治疗大脑大转移瘤：单机构经验及文献综述
Two-staged stereotactic radiosurgery for the treatment of large brain metastases: Single institution experience and review of literature.
作者信息
Ginalis Elizabeth E, Cui Taoran, Weiner Joseph, Nie Ke, Danish Shabbar
机构信息
Department of Neurological Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Radiation Oncology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
出版信息
J Radiosurg SBRT. 2020;7(2):105-114.
Two-staged stereotactic radiosurgery (SRS) has been shown as an effective treatment for brain metastases that are too large for single fraction SRS. Patients with large brain metastases (>4 cm) treated with two-staged SRS from January 2017 to December 2019 at our institution were retrospectively identified. There were 23 brain metastases treated. The normal brain volume receiving equivalent 12Gy-in-single-fraction was defined as V. The V for original single-fraction GKS plan (mean of 41.4 cm, range 5.6-146.1 cm) was significantly higher compared to that of the second stage (mean of 23.7 cm, range 2.8-92.7 cm). The median tumor volume measured at the second stage (4.30 cm) was reduced by an average of 52.2% compared to the first stage (9.58 cm). Three patients (27.3%) showed local tumor progression in 4 tumors (20%). The median time to progression was 152 days. Two-staged SRS is an effective treatment technique for large brain metastasis that results in significant reduction of tumor volume at the second stage SRS. Optimal treatment dose has not yet been defined.
对于体积过大而无法进行单次分割立体定向放射外科治疗（SRS）的脑转移瘤，两阶段立体定向放射外科治疗已被证明是一种有效的治疗方法。我们回顾性地确定了2017年1月至2019年12月在我院接受两阶段SRS治疗的大脑转移瘤较大（>4 cm）的患者。共治疗了23个脑转移瘤。将接受等效单分次12Gy的正常脑体积定义为V。原始单分次伽玛刀计划的V（平均41.4 cm，范围5.6 - 146.1 cm）显著高于第二阶段（平均23.7 cm，范围2.8 - 92.7 cm）。与第一阶段（9.58 cm）相比，第二阶段测量的肿瘤体积中位数（4.30 cm）平均减少了52.2%。3例患者（27.3%）的4个肿瘤（20%）出现局部肿瘤进展。进展的中位时间为152天。两阶段SRS是治疗大脑转移瘤的一种有效治疗技术，可在第二阶段SRS时使肿瘤体积显著减小。尚未确定最佳治疗剂量。
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