Linac-Based Fractionated Stereotactic Radiotherapy with a Micro-Multileaf Collimator for Brainstem Metastasis
Linac-Based Fractionated Stereotactic Radiotherapy with a Micro-Multileaf Collimator for Brainstem Metastasis
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DOI：
10.1016/j.wneu.2019.08.049
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发表时间：
2019-12-01
影响因子：
2
通讯作者：
Hasegawa, Masatoshi
中科院分区：
文献类型：
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作者：
Sugimoto, Tadashi;Matsuda, Ryosuke;Hasegawa, Masatoshi
背景技术背景：评估使用微型多叶准直器进行基于直线加速器的分次立体定向放射治疗（fSRT）治疗脑干转移瘤（BSM）患者的神经影像学和临床结局。（15名男性和9名女性）患有BSM（25处病变：中脑，10处;脑桥，13处;延髓，2处）的患者连续接受了基于linac的fSRT治疗。BSM来源于肺（n = 18，75.0%）、结肠（n = 3，12.5%）和乳腺（n = 3，12.5%）。患者的中位年龄为67.0岁（范围：42-80岁）。递归分区分析将2例患者分类为I类，17例为II类，5例为III类。结果：肿瘤体积范围为0.01 - 7.49 cm（3）（中位数：0.233 cm（3）），患者接受7-13次24-40戈伊剂量治疗。fSRT后的中位OS为9个月（95%置信区间4.104-13.896）。肿瘤体积大、脑干相关症状、治疗前Karnofsky功能状态差和递归分区分析III级与总生存率低显著相关。18个转移灶的肿瘤体积减小，6个保持稳定，1个增加。没有患者表现出永久性辐射损伤。1名接受皮质类固醇治疗的患者发生了根据不良事件通用术语标准4.0的2级恶心和呕吐。结论：基于Linac的fSRT和微型多叶准直器以24-40戈伊的剂量分7-13次输送，是BSM患者安全有效的局部治疗方法。
BACKGROUND: To assess the neuroimaging and clinical outcomes in patients with brainstem metastasis (BSM) treated with linac-based fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator.METHODS: Between May 2007 and January 2017, 24 patients (15 male and 9 female) with BSM (25 lesions: midbrain, 10; pons, 13; and medulla oblongata, 2) were consecutively treated with linac-based fSRT. BSM originated from the lung (n = 18, 75.0%), colon (n = 3, 12.5%), and breast (n = 3, 12.5%). The median patient age was 67.0 (range: 42-80) years. Recursive partition analysis classified 2 patients as class I, 17 as class II, and 5 as class III. Overall survival was calculated using the Kaplan-Meier method.RESULTS: Tumor volume ranged from 0.01 to 7.49 cm(3) (median: 0.233 cm(3)), and patients were treated with a dose of 24-40 Gy in 7-13 fractions. The median OS was 9 months after fSRT (95% confidence interval 4.104-13.896). Large tumor volume, presence of brainstem-related symptoms, poor pretreatment Karnofsky performance status, and recursive partition analysis class III were significantly associated with low overall survival. Tumor volume decreased in 18 metastatic lesions, remained stable in 6, and increased in 1. No patient exhibited permanent radiation injury. Grade 2 nausea and vomiting according to the Common Terminology Criteria for Adverse Events 4.0 occurred in 1 patient who received corticosteroids.CONCLUSIONS: Linac-based fSRT with a micro-multileaf collimator delivered in the doses of 24-40 Gy in 7-13 fractions is a safe and effective local therapy for patients with BSM.