Five-fraction CyberKnife radiotherapy for large brain metastases in critical areas: impact on the surrounding brain volumes circumscribed with a single dose equivalent of 14 Gy (V14) to avoid radiation necrosis.
Five-fraction CyberKnife radiotherapy for large brain metastases in critical areas: impact on the surrounding brain volumes circumscribed with a single dose equivalent of 14 Gy (V14) to avoid radiation necrosis.
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DOI：
10.1093/jrr/rrt127
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发表时间：
2014-03-01
影响因子：
2
通讯作者：
Nakano T
中科院分区：
文献类型：
--
作者：
Inoue HK;Sato H;Seto K;Torikai K;Suzuki Y;Saitoh J;Noda SE;Nakano T
评价五段式射波刀放射治疗脑关键部位大面积转移患者的疗效和毒性。78例患者共85例转移，包括肿瘤bbb30 cm3（直径4cm），采用五段式射波刀放射治疗，中位边际剂量为31 Gy，中位处方等剂量为58%。观察治疗后神经系统表现、局部肿瘤控制及不良反应的变化。测量以28.8 Gy（单次剂量相当于14 Gy: V14）为边界的周围脑体积，以评估放射性坏死的风险。55例患者中有28例（50.9%）的神经系统症状得到改善，如运动无力、视觉障碍和失语。在中位随访8个月期间，85例转移患者中有79例（92.9%）获得局部肿瘤控制。10例患者出现症状性水肿，其中2例（2.6%）因放射性坏死需要手术切除。V14为3.0 ~ 19.7 cm3。16个病变V14≥7.0 cm3，其中2个病变因放射性坏死而发生广泛脑水肿。V14 <7.0 cm3的患者均未出现需要手术干预的水肿。因此，我们得出结论，对于关键部位的大转移瘤，五段式射波刀放射治疗可以获得高的局部肿瘤控制率和低的并发症发生率。因此，脑周围的V14是判断大面积转移灶患者发生放射性坏死风险的有用指标。
The efficacy and toxicity of five-fraction CyberKnife radiotherapy were evaluated in patients with large brain metastases in critical areas. A total of 85 metastases in 78 patients, including tumors >30 cm3 (4 cm in diameter) were treated with five-fraction CyberKnife radiotherapy with a median marginal dose of 31 Gy at a median prescribed isodose of 58%. Changes in the neurological manifestations, local tumor control, and adverse effects were investigated after treatment. The surrounding brain volumes circumscribed with 28.8 Gy (single dose equivalent to 14 Gy: V14) were measured to evaluate the risk of radiation necrosis. Neurological manifestations, such as motor weakness, visual disturbances and aphasia improved in 28 of 55 patients (50.9%). Local tumor control was obtained in 79 of 85 metastases (92.9%) during a median follow-up of eight months. Symptomatic edema occurred in 10 patients, and two of them (2.6%) required surgical resection because of radiation necrosis. The V14 of these patients was 3.0–19.7 cm3. There were 16 lesions with a V14 of ≥7.0 cm3, and two of these lesions developed extensive brain edema due to radiation necrosis. None of the patients with a V14 of <7.0 cm3 exhibited edema requiring surgical intervention. We therefore conclude that a high rate of local tumor control and low rates of complications can be obtained after five-fraction CyberKnife radiotherapy for large metastases in critical areas. The V14 of the surrounding brain is therefore a useful indicator for the risk of radiation necrosis in patients with large metastases.
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影响因子：
2
作者：
Inoue HK;Seto K;Nozaki A;Torikai K;Suzuki Y;Saitoh J;Noda SE;Nakano T
通讯作者：
Nakano T
DOI：
10.1016/s0360-3016(96)00619-0
发表时间：
1997-03-01
影响因子：
7
作者：
Gaspar, L;Scott, C;Byhardt, R
通讯作者：
Byhardt, R
DOI：
10.1016/j.ijrobp.2011.06.1965
发表时间：
2012-05-01
影响因子：
7
作者：
Han, Jung Ho;Kim, Dong Gyu;Jung, Hee-Won
通讯作者：
Jung, Hee-Won
影响因子：
2
作者：
Iwata H;Matsufuji N;Toshito T;Akagi T;Otsuka S;Shibamoto Y
通讯作者：
Shibamoto Y
影响因子：
3.1
作者：
Fahrig, Antje;Ganslandt, Oliver;Hamm, Klaus
通讯作者：
Hamm, Klaus