Modified boron neutron capture therapy for malignant gliomas performed using epithermal neutron and two boron compounds with different accumulation mechanisms: an efficacy study based on findings on neuroimages
Modified boron neutron capture therapy for malignant gliomas performed using epithermal neutron and two boron compounds with different accumulation mechanisms: an efficacy study based on findings on neuroimages
复制标题
DOI：
10.3171/jns.2005.103.6.1000
复制
发表时间：
2005-12-01
影响因子：
4.1
通讯作者：
Ono, K
中科院分区：
文献类型：
--
作者：
Miyatake, SI;Kawabata, S;Ono, K
Object.为了提高硼中子俘获治疗（BNCT）对恶性胶质瘤的有效性，作者使用超热中子而不是热中子进行深度穿透，并使用两种具有不同积累机制的硼化合物-硼帽酸钠（BSH）和硼苯丙氨酸（BPA）来增加肿瘤中的硼水平，同时补偿彼此的缺陷。2002年1月至2003年12月期间，13例患者，其中10例患有多形性胶质母细胞瘤（GBM），1例胶质肉瘤，1例间变性星形细胞瘤，1例间变性少突星形细胞瘤，使用这种改良的BNCT治疗。术后，神经影像学显示，只有1例GBM患者术后无病变增强。患者接受F-18-BPA正电子发射断层扫描（如果可用），以评估中子放射治疗前BPA的积累和分布。在照射前使用放射治疗应用剂量计划系统的模拟环境估计中子注量率。使用磁共振（MR）成像或计算机断层扫描（CT）扫描对患者的体积进行评估。在放射治疗后2 ~ 7天，通过神经影像学检查评估肿瘤的改善情况，以确定BNCT的初始疗效;同时通过连续神经影像学检查分析其最大疗效。BNCT治疗前的平均肿瘤体积为42.3 cm（3）。无论BNCT前的肿瘤体积如何，在每例具有可评估病变的患者中，在初始评估（体积缩小率范围为17.4- 71%，平均率为46.4%）和随访评估（体积缩小率范围为30.3- 87.6%，平均率为58.5%）时均识别出MR或CT图像的改善。在随访期间，12例患者中有8例患者的造影剂增强病变消失超过50%。这种改良的BNCT在恶性胶质瘤中产生了良好的改善，如神经影像所示。
Object. To improve the effectiveness of boron neutron capture therapy (BNCT) for malignant gliomas, the authors used epithermal rather than thermal neutrons for deep penetration and two boron compounds-sodium borocaptate (BSH) and boronophenylalanine (BPA)-with different accumulation mechanisms to increase the boron level in tumors while compensating for each other's faults.Methods. Thirteen patients, 10 of whom harbored a glioblastoma multiforme (GBM), one gliosarcoma, one an anaplastic astrocytoma, and one an anaplastic oligoastrocytoma, were treated using this modified BNCT between January 2002 and December 2003. Postoperatively, neuroimaging revealed that only one patient with a GBM had no lesion enhancement postoperatively. The patients underwent F-18-BPA positron emission tomography, if available, to assess the accumulation and distribution of BPA before neutron radiotherapy. The neutron fluence rate was estimated using the Simulation Environments for Radiotherapy Applications dose-planning system before irradiation. The patients' volume assessments were performed using magnetic resonance (MR) imaging or computerized tomography (CT) scanning. Improvements in the disease as seen on neuroimages were assessed between 2 and 7 days after irradiation to determine the initial effects of BNCT; its maximal effects were also analyzed on serial neuroimages.The mean tumor volume before BNCT was 42.3 cm(3). Regardless of the pre-BNCT tumor volume, in every patient harboring an assessable lesion, improvements on MR or CT images were recognized both at the initial assessment (range of volume reduction rate 17.4-71%, mean rate 46.4%) and at follow-up assessments (range of volume reduction rates 30.3-87.6%, mean rate 58.5%). More than 50% of the contrast-enhanced lesions disappeared in eight of the 12 patients during the follow-up period.Conclusions. This modified BNCT produced a good improvement in malignant gliomas, as seen on neuroimages.