Chambrelant Isabelle, Jarnet Delphine, Bou-Gharios Jolie, Le Fèvre Clara, Kuntz Laure, Antoni Delphine, Jenny Catherine, Noël Georges
Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France.
Department of Medical Physics, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France.
Cancers (Basel). 2023 Aug 2;15(15):3937. doi: 10.3390/cancers15153937.
Stereotactic radiotherapy (SRT) plays a major role in treating brain metastases (BMs) and can be delivered using various equipment and techniques. This review aims to identify the dosimetric factors of each technique to determine whether one should be preferred over another for single BMs treatment. A systematic literature review on articles published between January 2015 and January 2022 was conducted using the MEDLINE and ScienceDirect databases, following the PRISMA methodology, using the keywords "dosimetric comparison" and "brain metastases". The included articles compared two or more SRT techniques for treating single BM and considered at least two parameters among: conformity (CI), homogeneity (HI) and gradient (GI) indexes, delivery treatment time, and dose-volume of normal brain tissue. Eleven studies were analyzed. The heterogeneous lesions along with the different definitions of dosimetric indexes rendered the studied comparison almost unattainable. Gamma Knife (GK) and volumetric modulated arc therapy (VMAT) provide better CI and GI and ensure the sparing of healthy tissue. To conclude, it is crucial to optimize dosimetric indexes to minimize radiation exposure to healthy tissue, particularly in cases of reirradiation. Consequently, there is a need for future well-designed studies to establish guidelines for selecting the appropriate SRT technique based on the treated BMs' characteristics.
立体定向放射治疗（SRT）在脑转移瘤（BMs）的治疗中发挥着重要作用，可通过各种设备和技术进行。本综述旨在确定每种技术的剂量学因素，以确定在治疗单个脑转移瘤时，是否应优先选择一种技术而非另一种。按照PRISMA方法，使用MEDLINE和ScienceDirect数据库，对2015年1月至2022年1月发表的文章进行了系统的文献综述，关键词为“剂量学比较”和“脑转移瘤”。纳入的文章比较了两种或更多种用于治疗单个脑转移瘤的SRT技术，并考虑了以下至少两个参数：适形性（CI）、均匀性（HI）和梯度（GI）指数、治疗时间以及正常脑组织的剂量体积。对11项研究进行了分析。病变的异质性以及剂量学指标的不同定义使得所研究的比较几乎无法实现。伽玛刀（GK）和容积调强弧形放疗（VMAT）提供了更好的CI和GI，并确保了健康组织的 sparing。总之，优化剂量学指标以尽量减少对健康组织的辐射暴露至关重要，特别是在再照射的情况下。因此，未来需要设计良好的研究来制定基于所治疗脑转移瘤的特征选择合适SRT技术的指南。
