Interstitial irradiation and hyperthermia for the treatment of recurrent malignant brain tumors.
Interstitial irradiation and hyperthermia for the treatment of recurrent malignant brain tumors.
复制标题
间质照射和热疗用于治疗复发性恶性脑肿瘤。
DOI：
10.1097/00006123-199102000-00006
复制
发表时间：
1991
期刊：
影响因子：
4.8
通讯作者：
Larson,DA
中科院分区：
文献类型：
--
作者：
Sneed,PK;Stauffer,PR;Gutin,PH;Phillips,TL;Suen,S;Weaver,KA;Lamb,SA;Ham,B;Prados,MD;Larson,DA
1987年6月至1989年6月，29复发恶性胶质瘤或复发性孤立性脑转移瘤的28例患者进行了治疗的I期研究间质照射和热疗。患者年龄范围为18 - 65岁，Karnofsky体能状态评分范围为40 - 90%。胶质母细胞瘤13例，间变性星形细胞瘤10例。3例黑色素瘤和3例腺癌。在基于计算机断层扫描的预先计划后，以立体定向方式植入导管。近距离放射治疗前后进行热疗，使用1至6个2450或915 MHz螺旋线圈微波天线和1至3个多传感器光纤测温探头。目标是将尽可能多的肿瘤加热到42.5摄氏度30分钟。在第一次热疗后30分钟内，植入导管后装高活性碘-125粒子，肿瘤剂量为32.6 - 61.0戈伊。大多数病人没有发热的感觉。并发症包括癫痫发作5例，可逆性神经系统改变9例，头皮烧伤1例，感染3例。在28例可评价的2个月随访扫描中，11例显示肿瘤的放射学表现明确改善，4例轻微改善，7例稳定，6例显示肿瘤进展。10例患者因持续性肿瘤和/或坏死接受了再次手术。28例患者中有11例在治疗后存活40至97周。13例患者死于脑肿瘤，2例死于颅外黑色素瘤转移，1例死于新发脑黑色素瘤转移，1例死于肺栓塞。总体中位生存期为55周。间变性星形细胞瘤亚组的中位生存期尚未达到。我们的结论是，使用螺旋线圈微波天线进行脑间质热疗在技术上是可行的。毒性水平是可以接受的，计算机断层扫描的反应率是令人鼓舞的。（神经外科28：206-215，1991）
: Between June 1987 and June 1989, 29 recurrent malignant gliomas or recurrent solitary brain metastases in 28 patients were treated in a Phase I study of interstitial irradiation and hyperthermia. Patient age ranged from 18 to 65 years, and the Karnofsky Performance Status scores ranged from 40 to 90%. There were 13 glioblastomas, 10 anaplastic astrocytomas. 3 melanomas, and 3 adenocarcinomas. Catheters were implanted stereotactically after computed tomography-based preplanning. Hyperthermia was administered before and after brachytherapy, using one to six 2450-or 915-MHz helical coil microwave antennas and one to three multisensor fiberoptic thermometry probes. The goal was to heat as much of the tumor as possible to 42.5 [degrees] C for 30 minutes. Within 30 minutes after the first hyperthermia treatment, implant catheters were afterloaded with high-activity iodine-125 seeds delivering tumor doses of 32.6 to 61.0 Gy. Most patients had no sensation of heating. Complications included seizures in 5 patients, reversible neurological changes in 9 patients, a scalp burn in 1, and infections in 3. Of 28 evaluable 2-month follow-up scans, 11 showed definite improvement in the radiological appearance of the tumor, 4 were slightly improved, 7 were stable, and 6 showed tumor progression. Ten patients underwent reoperation for persistent tumor and/or necrosis. Eleven of 28 patients are alive 40 to 97 weeks after treatment. Thirteen patients died of a brain tumor, 2 died of extracranial melanoma metastases, 1 died of new brain melanoma metastases, and 1 died of a pulmonary embolus. The median survival was 55 weeks overall. Median survival has not yet been reached for the anaplastic astrocytoma subgroup. We conclude that interstitial brain hyperthermia using helical coil microwave antennas is technically feasible. The level of toxicity is acceptable, and the computed tomographic response rate is encouraging.(Neurosurgery 28: 206-215 1991)