幕上脑转移瘤术中放疗切除术。安全吗？单中心队列分析与经验
Resection of supratentorial brain metastases with intraoperative radiotherapy. Is it safe? Analysis and experiences of a single center cohort.
作者信息
Krauss Philipp, Steininger Kathrin, Motov Stefan, Sommer Bjoern, Bonk Maximilian Niklas, Cortes Abraham, Wolfert Christina, Stueben Georg, Shiban Ehab, Kahl Klaus Henning
机构信息
Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany.
Department of Radiooncology, University Hospital Augsburg, Augsburg, Germany.
出版信息
Front Surg. 2022 Dec 26;9:1071804. doi: 10.3389/fsurg.2022.1071804. eCollection 2022.
INTRODUCTION
Intraoperative Radiotherapy (ioRT) is an emerging treatment option in oncologic surgery for various diseases including intraaxial brain lesions to improve surgical outcome and accelerate the adjuvant oncologic therapy. Despite its use in glioma surgery, the application and data regarding ioRT in the treatment of brain metastases (BMs) is sparse. Here were report the largest series of supratentorial BMs treated with resection and ioRT according to functional outcome and adverse events.
METHODS
We performed a retrospective chart review analysis of patients undergoing surgery for BMs following an interdisciplinary tumor board decision in every case with ioRT at our institution. Patient properties, functional status (Karnofsky Performance Score/KPS) before and after surgery as well as oncologic (disease, recursive partitioning analysis, lesion size) and operative parameters were analyzed until hospital discharge. Adverse events (AE) were recorded until 30 days after surgery and rated according to the Clavien Dindo Grading (CDG) scale.
RESULTS
70 patients (40 female) with various oncologic diseases were identified and analyzed. Six underwent prior RT. Mean age was 66 ± 11 years. Preoperative median KPS was 80% with a mean BM volume of 3.2 ± 1.2 cm. Nine patients (13%) experienced in total 14 AEs, including 2 cases (3%) of postoperative death (CDG5) and 2 with new postoperative epilepsy necessitating additional pharmacotreatment (CDG2). Five patients suffered from new neurologic deficit (CDG1) not needing further surgical or medical treatment. After surgery, the neurological status in 7 patients (10%) deteriorated while it improved in 21 cases (30%). Patients experiencing AEs had longer hospitalization and poorer postoperative KPS mdn. 90 vs. 80%. There was no statistically significant deterioration of the functional status during the immediate postoperative course in the whole patient cohort.
CONCLUSION
Surgery for supratentorial BMs with ioRT seems safe and feasible. Further studies on the benefit regarding oncologic outcome need to be performed.
引言
术中放疗（ioRT）是肿瘤外科中一种新兴的治疗选择，可用于治疗包括脑内病变在内的多种疾病，以改善手术效果并加速辅助肿瘤治疗。尽管其已应用于胶质瘤手术，但关于ioRT在脑转移瘤（BMs）治疗中的应用和数据却很稀少。在此，我们报告了根据功能结局和不良事件，采用手术切除和ioRT治疗幕上BMs的最大系列病例。
方法
我们对在我院接受跨学科肿瘤委员会决策后进行BMs手术且术中接受ioRT的患者进行了回顾性病历审查分析。分析患者的特征、手术前后的功能状态（卡诺夫斯基功能状态评分/KPS）以及肿瘤学（疾病、递归分区分析、病变大小）和手术参数，直至出院。记录术后30天内的不良事件（AE），并根据Clavien-Dindo分级（CDG）量表进行评分。
结果
共确定并分析了70例患有各种肿瘤疾病的患者（40例女性）。6例患者曾接受过放疗。平均年龄为66±11岁。术前中位KPS为80%，平均BM体积为3.2±1.2 cm。9例患者（13%）共经历了14次AE，包括2例（3%）术后死亡（CDG5）和2例术后新发癫痫需要额外药物治疗（CDG2）。5例患者出现新的神经功能缺损（CDG1），无需进一步手术或药物治疗。术后，7例患者（10%）的神经状态恶化，而21例患者（30%）的神经状态改善。发生AE的患者住院时间更长，术后KPS中位值更差，分别为90%和80%。在整个患者队列中，术后即刻功能状态无统计学意义上的恶化。
结论
采用ioRT治疗幕上BMs的手术似乎安全可行。需要对其在肿瘤学结局方面的益处进行进一步研究。
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