多中心研究“夹心治疗”直径大于 3 厘米的运动区大脑转移瘤（LBM）。
Multi-institutional study of 'Sandwich treatment' for motor area large brain metastases (LBM) with diameter over 3 cm.
机构信息
Cancer Center, Gamma Knife Treatment Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China.
Gamma Knife Treatment Center, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
出版信息
Radiol Oncol. 2024 Jan 6;58(1):145-152. doi: 10.2478/raon-2024-0002. eCollection 2024 Mar 1.
BACKGROUND
The objective of the present study was to explore the effectiveness and safety of 'Sandwich treatment' strategy for large brain metastases (LBM) with diameter over 3 cm (minimum volume >= 15 cm) located in motor area.
PATIENTS AND METHODS
Patients from four gamma knife center that received 'Sandwich treatment' were retrospectively studied from January 2016 to March 2023. The strategy was one-week treatment course including 2 stages of stereotactic radiosurgery (SRS) and using bevacizumab once during SRS gap. The tumor volume and peri-tumor edema changes were analyzed before and after 'Sandwich treatment'. Manual muscle testing (MMT) score and Barthel Index (BI) score were used to evaluate the changes of patients' movement and physical strength rehabilitation. The patients' overall survival (OS) and tumor local control (TLC) rate was calculated. Cox regression model was used to analyze the risk factors that related to TLC.
RESULTS
61 patients with 72 lesions received the 'Sandwich treatment'. The median prescription dose was 13.0 Gy and 12.5 Gy at the first- and second-stage SRS. The mean tumor volume at the time of 'Sandwich treatment' and 3 months later was 20.1 cm and 12.3, respectively (P < 0.01). The mean peri-tumor edema volume at the first- and second-stage SRS was 12.6 cm and 5.2 cm, respectively (P < 0.01). Patients' median MMT score improved from 6 at the beginning to 8 at the end of 'Sandwich treatment' (P < 0.01), BI score was also greatly improved from 45 at the time of 'Sandwich treatment' to 95 after 3 months (P < 0.01). Patients' median OS was 14.0 months, and the 3, 6, 12 months OS rate was 92.0%, 86.0% and 66.0%, respectively. The TLC rate at 3, 6, 12 months was 98.4%, 93.4%, and 85.3%, respectively. Patients with lung cancer had lower risk of tumor relapse. The cumulative incidence of patient's hemorrhage and radiation necrosis was 4.92% (3/61) and 13.11% (8/61) after 'Sandwich treatment'.
CONCLUSIONS
'Sandwich treatment' strategy is safe and effective for LBM located in motor area. The strategy could rapidly improve the patients' movement and enhance their physical strength rehabilitation.
背景
本研究旨在探讨直径大于 3cm（最小体积≥15cm）位于运动区的大脑转移瘤（LBM）的“三明治治疗”策略的有效性和安全性。
患者和方法
回顾性分析 2016 年 1 月至 2023 年 3 月期间在四个伽玛刀中心接受“三明治治疗”的患者。该策略是一个为期一周的治疗过程，包括 2 个阶段的立体定向放射外科手术（SRS）和在 SRS 间隙期间使用贝伐单抗一次。在“三明治治疗”前后分析肿瘤体积和肿瘤周围水肿的变化。采用徒手肌力测试（MMT）评分和巴氏指数（BI）评分评估患者运动和体力康复的变化。计算患者的总生存期（OS）和肿瘤局部控制（TLC）率。采用 Cox 回归模型分析与 TLC 相关的风险因素。
结果
61 例 72 个病灶患者接受了“三明治治疗”。第一阶段和第二阶段 SRS 的中位处方剂量分别为 13.0Gy 和 12.5Gy。“三明治治疗”时和 3 个月后的平均肿瘤体积分别为 20.1cm 和 12.3cm（P<0.01）。第一阶段和第二阶段 SRS 时的平均肿瘤周围水肿体积分别为 12.6cm 和 5.2cm（P<0.01）。患者的中位 MMT 评分从治疗开始时的 6 分提高到治疗结束时的 8 分（P<0.01），BI 评分也从“三明治治疗”时的 45 分显著提高到 3 个月后的 95 分（P<0.01）。患者的中位 OS 为 14.0 个月，3、6、12 个月的 OS 率分别为 92.0%、86.0%和 66.0%。3、6、12 个月的 TLC 率分别为 98.4%、93.4%和 85.3%。肺癌患者肿瘤复发的风险较低。“三明治治疗”后患者出血和放射性坏死的累积发生率为 4.92%（3/61）和 13.11%（8/61）。
结论
“三明治治疗”策略治疗位于运动区的 LBM 是安全有效的。该策略可迅速改善患者的运动功能，增强其体力康复能力。
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