术中放疗与辅助放疗治疗功能区脑转移瘤的疗效比较：可行性与安全性分析
Resection with intraoperative radiotherapy vs. adjuvant radiotherapy in the treatment of eloquent brain metastases: an analysis of feasibility and safety.
作者信息
Krauss Philipp, Colosimo Micol, Wolfert Christina, Stemmer Bastian, Sommer Bjoern, Mielke Dorothee, Stueben Georg, Kahl Klaus Henning, Shiban Ehab
机构信息
Department of Neurosurgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
BZKF, Bayerisches Zentrum für Krebsforschung, Augsburg, Germany.
出版信息
Neurosurg Rev. 2025 Apr 24;48(1):385. doi: 10.1007/s10143-025-03523-z.
INTRODUCTION
The treatment of motor eloquent brain metastases (BM) harbors an elevated risk of neurological deficits due to possible damage to motor-cortex and tracts. Preserving a good functional and neurological status is crucial to enable comprehensive oncologic treatment. Growing evidence promotes intraoperative radiotherapy (IORT) with low voltage x-rays as alternative to adjuvant external beam radiotherapy (EBRT). Aim of this study is to investigate the safety and feasibility of surgery with IORT in motor eloquent regions compared to adjuvant radiotherapy (RT).
METHODS
We performed a retrospective chart review analysis of patients undergoing surgery for motor eloquent BMs at our institution with either IORT or adjuvant RT. All patients were resected under intraoperative neuromonitoring (IONM). We compared patient characteristics, the rate of neurological deficits along with IONM parameters, functional status (KPS) and adverse events (AE) in both groups.
RESULTS
33 patients were analyzed from which 25 underwent IORT and 8 adjuvant EBRT in motor eloquent BMs. New motor deficits occurred in 7/33 patients without significant difference between both groups after 30 days (IORT 4/25 vs. adj. RT 3/8; Chi [2]-test: p = 0.19). The KPS after surgery did not differ significantly between both groups (IORT: 90% [72.5-90] vs. adj. RT: 80% [70-90]; Mann-Whitney-U-test: p = 0.31). No patient experienced local tumor recurrence or radio necrosis. 9/33 patients experienced postoperative AEs until the 30 day follow up without significantly different rates between both groups (IORT 5/25 vs. adj. RT 4/8; Chi [2]-test: p = 0.09).
CONCLUSION
50 kV photon IORT is a safe treatment option for motor eloquent BMs and does not seem to provoke in symptomatic brain irritation.
引言
运动功能区脑转移瘤（BM）的治疗因可能损伤运动皮层和神经束而导致神经功能缺损的风险较高。保持良好的功能和神经状态对于进行全面的肿瘤治疗至关重要。越来越多的证据表明，低电压X线术中放疗（IORT）可作为辅助外照射放疗（EBRT）的替代方法。本研究的目的是探讨与辅助放疗（RT）相比，在运动功能区进行IORT手术的安全性和可行性。
方法
我们对在本机构接受IORT或辅助RT治疗运动功能区BM的患者进行了回顾性病历分析。所有患者均在术中神经监测（IONM）下进行切除。我们比较了两组患者的特征、神经功能缺损发生率以及IONM参数、功能状态（KPS）和不良事件（AE）。
结果
分析了33例患者，其中25例在运动功能区BM接受了IORT治疗，8例接受了辅助EBRT治疗。33例患者中有7例出现了新的运动功能缺损，两组在30天后无显著差异（IORT组4/25 vs.辅助RT组3/8；卡方检验：p = 0.19）。两组术后KPS无显著差异（IORT组：90%[72.5 - 90] vs.辅助RT组：80%[70 - 90]；曼-惠特尼U检验：p = 0.31）。没有患者出现局部肿瘤复发或放射性坏死。33例患者中有9例在30天随访时出现术后AE，两组发生率无显著差异（IORT组5/25 vs.辅助RT组4/8；卡方检验：p = 0.09）。
结论
50 kV光子IORT是治疗运动功能区BM的一种安全选择，似乎不会引起有症状的脑部刺激。
Zotero 插件