VARIABLES ASSOCIATED WITH THE DEVELOPMENT OF COMPLICATIONS FROM RADIOSURGERY OF INTRACRANIAL TUMORS
VARIABLES ASSOCIATED WITH THE DEVELOPMENT OF COMPLICATIONS FROM RADIOSURGERY OF INTRACRANIAL TUMORS
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DOI：
10.1016/0360-3016(91)90675-t
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发表时间：
1991-08-01
影响因子：
7
通讯作者：
LOEFFLER, JS
中科院分区：
文献类型：
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作者：
NEDZI, LA;KOOY, H;LOEFFLER, JS
自86年5月21日至1989年11月1日，我们在联合放射治疗中心用改良的6 MeV直线加速器治疗了60例(40例原发灶，24例转移灶)复发或不能手术的颅内肿瘤。随访至死亡或1/1/90。中位随访时间为8个月(2~43个月)。14名患者在放疗后12小时至7个月(中位数为3个月，但只有2名患者超过4个月)出现并发症。为了确定与并发症相关的变量，我们计算了61/病变和周围CT定义的正常组织的积分剂量-体积直方图。我们排除了15名患者的16个病灶，进行了4个月的随访(12名患者)或治疗信息不足(3名患者)。在单变量评分检验中，较高的值与明显更多的毒性相关的变量是：a)肿瘤剂量不均匀(p<；0.00001)，b)最大肿瘤剂量(p=0.00002)，c)等中心数目(p=0.00002)，d)最大正常组织剂量(p=0.00005)和e)肿瘤体积(p=0.0001)。这些变量均与肿瘤剂量不均匀高度相关(等级相关系数0.75~4.81)。在Logistic模型中，肿瘤剂量不均匀的对数似然比任何其他单变量都要高得多，并且比任何其他两个变量加起来的对数似然更高。21例有转移灶的患者中无一例出现并发症。当我们排除转移性病变时，上述五个变量在单变量检验中仍然显著。平均肿瘤剂量、治疗弧数、总弧度、肿瘤部位、既往放射治疗、肿瘤几何形状、治疗效果状态、准直器大小和年龄与毒性无关。我们的结论是，颅内肿瘤的放射外科治疗与单一等中心至最大肿瘤剂量25Gy10Gy肿瘤剂量不均匀的肿瘤并发症的低风险相关，但较大的病变的治疗将需要新的治疗策略，减少与多等中心治疗相关的肿瘤剂量不均匀。
Between 5/21/86 and 11/1/89, we treated 64 recurrent or inoperable intracranial tumors in 60 patients (40 primary, 24 metastatic) with stereotactic radiosurgery using a modified 6 MeV linear accelerator at the Joint Center for Radiation Therapy. Patients were followed until death or 1/1/90. The median follow-up was 8 months (2-43 months). Fourteen patients experienced complications from 12 hours to 7 months (median 3 months, but only two patients more than 4 months) following radiosurgery. To determine variables related to complication, we calculated integral dose-volume histograms for 61/64 lesions and the surrounding CT-defined normal tissue. We excluded 16 lesions in 15 patients for follow-up < 4 months (12 patients) or insufficient treatment information (3 patients). The variables for which higher values were associated with significantly more toxicity in a univariate score test were: a) tumor dose inhomogeneity (p < 0.00001), b) maximum tumor dose (p = 0.00002), c) number of isocenters (p = 0.00002), d) maximum normal tissue dose (p = 0.00005) and e) tumor volume (p = 0.0001). These variables were all highly correlated with tumor dose inhomogeneity (coefficients of rank correlation 0.75 4.81). Tumor dose inhomogeneity had a much higher loglikelihood in a logistic model than any other single variable and a higher loglikelihood than any other two variables combined. None of the 21 patients with metastatic lesions experienced a complication. When we excluded the metastatic lesions, the above five variables remained significant in univariate tests. The mean tumor dose, number of treatment arcs, total degrees of are, tumor location, previous radiotherapy, tumor geometry, pretreatment performance status, collimator size, and age were not significantly associated with toxicity. We conclude that radiosurgery of intracranial tumors is associated with a low risk of complications for lesions < l0cc treated with a single isocenter to maximum tumor doses < 25 Gy with tumor dose inhomogeneity < 10 Gy, but that treatment of larger lesions will require new treatment strategies which reduce the tumor dose inhomogeneity associated with multiple isocenter treatments.