Frameless, Real-Time, Surface Imaging-Guided Radiosurgery: Clinical Outcomes for Brain Metastases
Frameless, Real-Time, Surface Imaging-Guided Radiosurgery: Clinical Outcomes for Brain Metastases
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DOI：
10.1227/neu.0b013e3182647ad5
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发表时间：
2012-10-01
期刊：
影响因子：
4.8
通讯作者：
Lawson, Joshua D.
中科院分区：
文献类型：
--
作者：
Pan, Hubert;Cervino, Laura I.;Lawson, Joshua D.
背景技术背景：无框架立体定向放射外科常用于治疗颅内转移瘤，但面罩固定可能会使患者感到不适。目的：描述使用新型实时、无框架、表面成像引导放射外科（SIG-RS）技术治疗脑转移瘤的临床结局。方法：前瞻性收集了44例连续患者的数据，共计115例颅内转移瘤，接受了SIG-RS治疗，中位数为1次（范围，1-5）至20戈伊（范围，1 - 5 -30戈伊）的中位剂量。局部控制，区域控制，和总生存率估计的Kaplan-Meier法。结果：所有患者的中位随访时间为6.0个月（范围，0.3-21.6个月），31 44（70%）死亡的时间分析。35例患者（80%）进行了随访成像，共88处病变可评价局部控制。精算6个月和12个月局部控制分别为90%（95%置信区间，82-98）和76%（95%置信区间，60-91）。在16例患者（46%）中观察到局部失败。中位精算总生存期为7.7个月（95%置信区间，5.7-9.7）。对22例在单次治疗中单独接受SIG-RS（既往未接受治疗）的患者（55处病变）的亚组进行分析，获得了相当的临床结局。4例患者（9%）发生3级或以上毒性。从射束开启到射束关闭的中位治疗时间为15分钟（范围，3-36分钟）。结论：治疗颅内转移瘤的SIG-RS可产生与传统的基于框架和无框架立体定向放射外科技术相当的临床结局，同时通过开放式面罩和快速治疗时间提供更大的患者舒适度。
BACKGROUND: Frameless stereotactic radiosurgery is commonly used to treat intracranial metastases, but mask-based immobilization can be uncomfortable for patients.OBJECTIVE: To describe the clinical outcomes using a novel real-time, frameless, surface imaging-guided radiosurgery (SIG-RS) technique to treat brain metastases.METHODS: Data were prospectively gathered for 44 consecutive patients totaling 115 intracranial metastases treated with SIG-RS in a median of 1 fraction (range, 1-5) to a median dose of 20 Gy (range, 15-30 Gy). Local control, regional control, and overall survival were estimated by the Kaplan-Meier method.RESULTS: Median follow-up for all patients was 6.0 months (range, 0.3-21.6 months), with 31 of 44 (70%) deceased at the time of analysis. The 35 patients (80%) with followup imaging totaled 88 lesions evaluable for local control. Actuarial 6- and 12-month local control was 90% (95% confidence interval, 82-98) and 76% (95% confidence interval, 60-91), respectively. Regional failure was observed in 16 patients (46%). The median actuarial overall survival was 7.7 months (95% confidence interval, 5.7-9.7). Analysis of the subset of 22 patients (55 lesions) who received SIG-RS alone (no prior treatment) in a single fraction yielded comparable clinical outcomes. Grade 3 or greater toxicity occurred in 4 patients (9%). The median treatment time from beam on to beam off was 15 minutes (range, 3-36 minutes).CONCLUSION: SIG-RS for treating intracranial metastases can produce clinical outcomes comparable to those with conventional frame-based and frameless stereotactic radiosurgery techniques while providing greater patient comfort with an open-faced mask and fast treatment times.