Schupak K, Malkin M, Anderson L, Arbit E, Lindsley K, Leibel S
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):1167-76. doi: 10.1016/0360-3016(94)00652-2.
To correlate the pattern of failure and subsequent survival with the technical accuracy of stereotactic brain tumor implantation.
The patterns of failure of 47 consecutive patients with primary or recurrent gliomas after stereotactic implantation delivering 60 Gy via removable high activity 125I sources were reviewed. When the tumor was covered at all levels by the chosen isodose distribution, the implant was considered to be "ideal." If the coverage was not complete, a numerical description of the volume of tumor outside the isodose was assigned. Criteria for "adequate" and "inadequate" implants were defined. Standard radiographic criteria, with pathologic confirmation in 26 cases, were used to categorize the patterns of failure into the following components: central, peripheral, distant (within the brain parenchyma), leptomeningeal, and spinal. A peripheral failure was scored as being in the "direction of error" when the prescribed isodose did not cover the tumor volume and the subsequent tumor progression was in this region. Survival was calculated from the date of implantation.
Of 47 cases examined, 72% had an element of central and/or peripheral failure and 23% had a component of distant or meningeal failure. Among the patients with "adequate" or "inadequate" ("nonideal") implants who had a component of peripheral failure, only 19% were in the "direction of error." All patients with technically "inadequate" implants progressed in both the central and peripheral region. Among the groups who had "ideal," "adequate," and "inadequate" implants; 37%, 70%, and 75%, respectively, underwent reoperation [p = not significant (NS)]. Patients who underwent reoperation had a longer median survival than those who did not; 521 days vs. 298 days, respectively (p = 0.035). For patients with "nonideal" implants, a median survival of 470 days was found for patients undergoing reoperation vs. 184 days for those who did not (p = 0.016).
(a) Patients with "inadequate" implants failed in both the central and peripheral region in all cases. This pattern, while less common in those with "ideal" or "adequate" implants, occurred in the majority of cases. (b) The technical excellence of the implant had no impact on survival. (c) Patients with "nonideal" implants were more likely to have reoperation than those with "ideal" implants, and this intervention was associated with a significant survival advantage.
将立体定向脑肿瘤植入的失败模式及后续生存率与技术准确性相关联。
回顾了47例连续的原发性或复发性胶质瘤患者在通过可移除的高活性125I源进行立体定向植入并给予60 Gy剂量后的失败模式。当肿瘤在所有层面都被所选的等剂量分布覆盖时，植入被认为是“理想的”。如果覆盖不完整，则对等剂量线外的肿瘤体积进行数值描述。定义了“充分”和“不充分”植入的标准。采用标准影像学标准，并对26例进行病理证实，将失败模式分为以下几种类型：中心型、周边型、远处（脑实质内）、软脑膜型和脊髓型。当规定的等剂量线未覆盖肿瘤体积且后续肿瘤进展发生在该区域时，周边型失败被计为“误差方向”。从植入日期开始计算生存率。
在47例接受检查的病例中，72%存在中心和/或周边型失败因素，23%存在远处或脑膜型失败因素。在有周边型失败因素的“充分”或“不充分”（“非理想”）植入患者中，只有19%处于“误差方向”。所有技术上“不充分”植入的患者在中心和周边区域均出现进展。在有“理想”、“充分”和“不充分”植入的组中，分别有37%、70%和75%的患者接受了再次手术[p = 无显著差异（NS）]。接受再次手术的患者的中位生存期比未接受再次手术的患者长；分别为521天和298天（p = 0.035）。对于“非理想”植入的患者，接受再次手术的患者中位生存期为470天，未接受再次手术的患者为184天（p = 0.016）。
（a）“不充分”植入的患者在所有病例中中心和周边区域均失败。这种模式在“理想”或“充分”植入的患者中较少见，但在大多数病例中出现。（b）植入的技术优劣对生存率没有影响。（c）“非理想”植入的患者比“理想”植入的患者更有可能接受再次手术，并且这种干预与显著的生存优势相关。
