Defining the Optimal Planning Target Volume in Image-Guided Stereotactic Radiosurgery of Brain Metastases: Results of a Randomized Trial
Defining the Optimal Planning Target Volume in Image-Guided Stereotactic Radiosurgery of Brain Metastases: Results of a Randomized Trial
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DOI：
10.1016/j.ijrobp.2014.09.004
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发表时间：
2015-01-01
影响因子：
7
通讯作者：
Yin, Fang-Fang
中科院分区：
文献类型：
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作者：
Kirkpatrick, John P.;Wang, Zhiheng;Yin, Fang-Fang
目的：探讨脑转移瘤立体定向放射手术（SRS）的最佳靶体积（GTV）范围，以减少肿瘤毒性和局部复发。方法和材料：1 - 3例最大尺寸小于4cm的脑转移，未接受过脑放射治疗，Karnofsky性能状态（KPS）在70以上的成年患者符合该机构审查委员会批准的试验条件。个体病变随机分为1或3毫米均匀扩张的GTV对比增强磁共振成像（MRI）定义。使用基于线性加速器的图像引导系统，将得到的规划靶体积（PTV）分别处理为24、18或15 Gy的边际剂量，最大PTV直径分别小于2、2至2.9和3至3.9 cm。主要终点是局部复发（LR）。次要终点包括神经认知迷你精神状态检查、轨迹测试A和B部分、生活质量（肿瘤治疗-脑功能评估）、放射性坏死（RN）、补救性放射治疗需求、脑远端衰竭（DF）和总生存期（OS）。结果：2010年2月至2012年11月，治疗了49例80例脑转移瘤。中位年龄为61岁，中位KPS为90，主要组织学为非小细胞肺癌（25例）和黑色素瘤（8例）。55个、19个和6个病变分别接受24、18和15 Gy的治疗。3-mm组PTV/GTV比值、接受12gy及以上的体积、PTV最小剂量均显著高于对照组（P < 0.05）
Purpose: To identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence.Methods and Materials: Adult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board-approved trial. Individual lesions were randomized to 1- or 3-mmuniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator-based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS).Results: Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non-small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P