Hypofractionated stereotactic radiotherapy for brain metastases
Hypofractionated stereotactic radiotherapy for brain metastases
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DOI：
10.1007/s00066-007-1714-1
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发表时间：
2007-11-01
影响因子：
3.1
通讯作者：
Hamm, Klaus
中科院分区：
文献类型：
--
作者：
Fahrig, Antje;Ganslandt, Oliver;Hamm, Klaus
目的：评价三种不同剂量概念的低分割立体定向放疗（hfSRT）在无创颅骨固定治疗不可切除、不能行放射手术（SRS）的脑转移瘤中的疗效和毒性。患者和方法：从2000年6月到2005年6月，在两个德国治疗中心的专用立体定向放射外科系统Novalis (TM) （BrainLAB, Feldkirchen，德国）治疗了150例脑转移患者，共228例。应用了三种不同的剂量概念：5 x 6-7 Gy （A: 72个脑转移），10 x 4 Gy （B: 59个脑转移）和7 x 5 Gy （C: 97个脑转移）。计划目标体积（PTV）中位数为6.1 cm(3)（范围0.02 ~ 95.97）。结果：完全缓解（CR）、部分缓解（PR）、无变化（NC）和进展性疾病（PD）的发生率分别为42%、30%、21%和7%（中位随访28个月）。中位生存期为16个月。6个月和12个月的生存率分别为83%和66%。副作用取决于PTV和剂量概念（水肿或坏死加重时的中位PTV: 17 cm3， A: 22%, C: 7%）。10 x 4 Gy (B)的HfSRT耐受性良好，无副作用。结论：低分割立体定向放疗是一种安全有效的治疗方法。对于脑转移瘤> 15 cm(3)（直径> 3 cm）和毒性，10 x 4 Gy似乎比高剂量的短分割更有利，而5 x 6-7 Gy和7 x 5 Gy之后的反应率更高。还需要根据不同的脑区进一步确定耐受性剂量和耐受性。
Purpose: To evaluate efficacy and toxicity of hypofractionated stereotactic radiotherapy (hfSRT) with three different dose concepts for irresectable brain metastases not amenable to radiosurgery (SRS) using non-invasive fixation of the skull.Patients and Methods: From 6/2000 to 6/2005, 150 patients with 228 brain metastases were treated at the dedicated stereotactic radiosurgery system Novalis (TM) (BrainLAB, Feldkirchen, Germany) in two German treatment centers. Three different dose concepts were applied: 5 x 6-7 Gy (A: 72 brain metastases), 10 x 4 Gy (B: 59 brain metastases) and 7 x 5 Gy (C: 97 brain metastases). Median planning target volume (PTV) was 6.1 cm(3) (range, 0.02-95.97).Results: Rates of complete remission (CR), partial remission (PR), no change (NC) and progressive disease (PD) were 42%, 30%, 21% and 7%, respectively (median follow-up 28 months). Median survival was 16 months. Survival at 6 and 12 months was 83% and 66%, respectively. Side effects were dependent on the PTV and on dose concept (median PTV in case of increasing edema or necrosis: 17 cm3, A: 22%, C: 7%). HfSRT with 10 x 4 Gy (B) was well tolerated without side effects.Conclusion: Hypofractionated stereotactic radiotherapy is an effective and safe treatment. In case of brain metastases > 15 cm(3) (diameter > 3 cm) and concerning toxicity, 10 x 4 Gy seem to be more advantageous than shorter fractionation with higher doses while 5 x 6-7 Gy and 7 x 5 Gy were followed by higher response rates. Further specification of tolerance doses and tolerance according to the different brain regions has to be done.