Pseudoprogression in boron neutron capture therapy for malignant gliomas and meningiomas
Pseudoprogression in boron neutron capture therapy for malignant gliomas and meningiomas
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DOI：
10.1215/15228517-2008-107
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发表时间：
2009-08-01
期刊：
影响因子：
15.9
通讯作者：
Ono, Koji
中科院分区：
文献类型：
--
作者：
Miyatake, Shin-Ichi;Kawabata, Shinji;Ono, Koji
恶性胶质瘤的治疗中，假进展已被公认并被广泛接受，因为在放化疗后，特别是使用替莫唑胺后，增强区域的体积短暂增加。我们在使用硼中子俘获疗法（BNCT）治疗恶性胶质瘤和脑膜瘤时也经历了类似的现象，BNCT是一种细胞选择性的粒子辐射形式。在此，我们介绍了代表性的病例，并分析了发病机制。回顾性分析了52例恶性胶质瘤和13例恶性脑膜瘤的BNCT表现。52例恶性胶质瘤中11例和13例恶性脑膜瘤中3例在BNCT后3个月内出现一过性增强体积增加。在这些病例中，5例胶质瘤患者因怀疑复发而接受手术。在组织学上，大多数标本显示坏死和少量残留肿瘤细胞。Ki-67标记显示，与以前的样品从个人相比，阳性减少。氟标记的硼苯丙氨酸PET分别应用于4例和2例恶性胶质瘤和脑膜瘤，在短暂增加的病变。这些PET扫描显示，与BNCT之前获得的扫描相比，所有病例的病变：正常脑比率均降低。无论是否进行手术，观察期间所有病变的大小均减小或稳定。恶性胶质瘤和脑膜瘤在BNCT后瞬时增强体积的增加似乎是假进展。这种发病机制被认为是BNCT后亚急性期的治疗相关肿瘤内坏死。Neuro-Oncology 11，430-436，2009（Posted to Neuro-Oncology [serial online]，Doc. D 08 -00183，2009年3月16日。网址http://neuro-oncology.dukejournals.org; DOI：10.1215/15228517-2008-107）
Pseudoprogression has been recognized and widely accepted in the treatment of malignant gliomas, as transient increases in the volume of the enhanced area just after chemoradiotherapy, especially using temozolomide. We experienced a similar phenomenon in the treatment of malignant gliomas and meningiomas using boron neutron capture therapy (BNCT), a cell-selective form of particle radiation. Here, we introduce representative cases and analyze the pathogenesis. Fifty-two cases of malignant glioma and 13 cases of malignant meningioma who were treated by BNCT were reviewed retrospectively mainly via MR images. Eleven of 52 malignant gliomas and 3 of 13 malignant meningiomas showed transient increases of enhanced volume in MR images within 3 months after BNCT. Among these cases, five patients with glioma underwent surgery because of suspicion of relapse. In histology, most of the specimens showed necrosis with small amounts of residual tumor cells. Ki-67 labeling showed decreased positivity compared with previous samples from the individuals. Fluoride-labeled boronophenylalanine PET was applied in four and two cases of malignant gliomas and meningiomas, respectively, at the time of transient increase of lesions. These PET scans showed decreased lesion: normal brain ratios in all cases compared with scans obtained prior to BNCT. With or without surgery, all lesions were decreased or stable in size during observation. Transient increases in enhanced volume in malignant gliomas and meningiomas immediately after BNCT seemed to be pseudoprogression. This pathogenesis was considered as treatment-related intratumoral necrosis in the subacute phase after BNCT. Neuro-Oncology 11, 430-436, 2009 (Posted to Neuro-Oncology [serial online], Doc. D08-00183, March 16, 2009. URL http://neuro-oncology.dukejournals.org; DOI: 10.1215/15228517-2008-107)