Department of General Neurosurgery, Centre of Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany.
Department of Stereotaxy and Functional Neurosurgery, Centre of Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, 50937, Germany.
J Cancer Res Clin Oncol. 2021 Sep;147(9):2765-2773. doi: 10.1007/s00432-021-03564-z. Epub 2021 Feb 26.
The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature.
All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan-Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE).
We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1-3 were observed in 12%.
Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.
立体定向放射外科的分次治疗（hSRS）的引入扩展了治疗模式，超出了单剂量立体定向放射外科和分割放疗的既定范围。在这里，我们报告使用 Cyberknife（CK-hSRS）治疗具有严重脑转移瘤（BM）和极差预后的患者的 hSRS 的疗效和副作用。我们根据当前文献讨论我们的经验。
回顾性纳入了 3 年内接受 CK-hSRS 的所有患者。我们应用 27Gy 的表面剂量，分为 3 个剂量。使用 Kaplan-Meier 方法估计局部控制率（LC）、全身无进展生存率（PFS）和总生存率（OS）。使用常见不良事件术语标准（CTCAE）对治疗相关并发症进行分级。
我们分析了 34 例 75 个脑转移瘤患者。53%的患者肿瘤较大，32%肿瘤位置重要，15%肿瘤位置深。36%的肿瘤是在先前放疗后复发的。中位 Karnofsky 表现状态为 65%。LC 的 3、6 和 12 个月累积生存率分别为 98%、98%和 78.6%。3、6 和 12 个月的 PFS 分别为 38%、32%和 15%，OS 分别为 65%、47%和 28%。中位 OS 与较高的 KPS 显著相关，KPS 是生存的唯一显著因素。观察到 12%的 CTCAE 1-3 级并发症。
我们的放疗方案显示出合理的治疗效果和耐受性。代表了对预后极差和临床表现状态患者的严重脑转移瘤的最佳挽救治疗，CK-hSRS 可能缩小手术、立体定向放射外科、常规放疗和姑息治疗之间的差距。
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