Turna Menekse, Çağlar Hale Başak
Anadolu Medical Center, Department of Radiation Oncology, Gebze, Kocaeli, Turkey.
Clin Transl Radiat Oncol. 2025 Jun 24;54:101000. doi: 10.1016/j.ctro.2025.101000. eCollection 2025 Sep.
Stereotactic radiosurgery is a widely used treatment modality for brain metastases, particularly in cases with a limited number and volume of lesions. While adaptive strategies have gained prominence in the stereotactic treatment of extracranial, their application in intracranial SRS remains largely unexplored. This case study presents a 45-year-old female with multiple brain metastases and significant perilesional edema, treated with fractionated stereotactic radiotherapy. Due to tumor displacement during the treatment course, adaptive SRS was implemented after the third fraction, utilizing an updated MRI scan to account for changes in tumor volume and midline shift. The total GTV decreased by 34.2 %, and five lesions were found to be partially outside the prescribed treatment target. Based on this MRI, an offline adaptive SRS plan was generated, and the remaining two fractions were delivered according to the updated plan. This case underscores the potential for significant changes in target volume and spatial displacement during FSRT in patients with brain metastases exhibiting extensive edema and emphasizes the importance of mid-treatment imaging and the potential role of offline adaptive SRS strategies in managing intracranial tumors.
立体定向放射外科是一种广泛应用于脑转移瘤的治疗方式，尤其适用于病灶数量和体积有限的病例。虽然自适应策略在颅外立体定向治疗中已受到广泛关注，但其在颅内立体定向放射外科中的应用仍有待深入探索。本病例报告了一名45岁女性，患有多发脑转移瘤且瘤周水肿明显，接受了分次立体定向放射治疗。在治疗过程中，由于肿瘤移位，在第三次分次治疗后实施了自适应立体定向放射外科治疗，利用更新的磁共振成像扫描来考虑肿瘤体积变化和中线移位。总体肿瘤靶体积（GTV）减少了34.2%，发现有5个病灶部分超出了规定的治疗靶区。基于该磁共振成像，生成了离线自适应立体定向放射外科治疗计划，并根据更新后的计划进行了剩余两次分次治疗。本病例强调了在伴有广泛水肿的脑转移瘤患者的分次立体定向放射治疗过程中，靶体积和空间移位可能发生显著变化，并强调了治疗中期成像的重要性以及离线自适应立体定向放射外科治疗策略在颅内肿瘤管理中的潜在作用。
