Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
German Cancer Consortium (DKTK), Munich, Germany.
Strahlenther Onkol. 2021 Jul;197(7):601-613. doi: 10.1007/s00066-021-01773-6. Epub 2021 Apr 21.
Single-isocenter dynamic conformal arc (SIDCA) therapy is a technically efficient way of delivering stereotactic radiosurgery (SRS) to multiple metastases simultaneously. This study reports on the safety and feasibility of linear accelerator (LINAC) based SRS with SIDCA for patients with multiple brain metastases.
All patients who received SRS with this technique between November 2017 and June 2019 within a prospective registry trial were included. The patients were irradiated with a dedicated planning tool for multiple brain metastases using a LINAC with a 5 mm multileaf collimator. Follow-up was performed every 3 months, including clinical and radiological examination with cranial magnetic resonance imaging (MRI). These early data were analyzed using descriptive statistics and the Kaplan-Meier method.
A total of 65 patients with 254 lesions (range 2-12) were included in this analysis. Median beam-on time was 23 min. The median follow-up at the time of analysis was 13 months (95% CI 11.1-14.9). Median overall survival and median intracranial progression-free survival was 15 months (95% CI 7.7-22.3) and 7 months (95% CI 3.9-10.0), respectively. Intracranial and local control after 1 year was 64.6 and 97.5%, respectively. During follow-up, CTCAE grade I adverse effects (AE) were experienced by 29 patients (44.6%; 18 of them therapy related, 27.7%), CTCAE grade II AEs by four patients (6.2%; one of them therapy related, 1.5%), and CTCAE grade III by three patients (4.6%; none of them therapy related). Two lesions (0.8%) in two patients (3.1%) were histopathologically proven to be radiation necrosis.
Simultaneous SRS using SIDCA seems to be a feasible and safe treatment for patients with multiple brain metastases.
单中心动态适形弧（SIDCA）治疗是一种同时向多个转移灶提供立体定向放射外科（SRS）的技术效率方法。本研究报告了使用直线加速器（LINAC）基于 SIDCA 对多个脑转移瘤患者进行 SRS 的安全性和可行性。
所有在 2017 年 11 月至 2019 年 6 月期间在一项前瞻性注册试验中接受该技术 SRS 的患者均被纳入本研究。使用带有 5mm 多叶准直器的 LINAC 通过专用多脑转移灶计划工具对患者进行放射治疗。每 3 个月进行一次随访，包括对颅磁共振成像（MRI）进行临床和影像学检查。使用描述性统计和 Kaplan-Meier 方法分析这些早期数据。
共纳入 65 例患者的 254 个病灶（范围 2-12）。中位照射时间为 23 分钟。分析时的中位随访时间为 13 个月（95%CI 11.1-14.9）。中位总生存期和中位颅内无进展生存期分别为 15 个月（95%CI 7.7-22.3）和 7 个月（95%CI 3.9-10.0）。1 年后颅内和局部控制率分别为 64.6%和 97.5%。在随访期间，29 例（44.6%；其中 18 例与治疗相关，27.7%）患者经历了 CTCAE 1 级不良事件（AE），4 例（6.2%；其中 1 例与治疗相关，1.5%）患者经历了 CTCAE 2 级 AE，3 例（4.6%；均与治疗无关）患者经历了 CTCAE 3 级 AE。两名患者（3.1%）的两个病灶（0.8%）经组织病理学证实为放射性坏死。
使用 SIDCA 的同时 SRS 似乎是治疗多个脑转移瘤患者的一种可行且安全的治疗方法。
