在现代系统性治疗时代,用于大脑转移的低剂量放射外科手术
Juan Diego Alzate1, Elad Mashiach1, Assaf Berger1
1Department of Neurological Surgery, NYU Langone Health, New York University, New York , New York , USA.
Neurosurgery
|June 16, 2023
概括
针对大脑转移 (BMs) 的低剂量立体射线手术 (SRS) 可以实现良好的局部控制 (LC) 和低毒性. 瘤体积,黑色素瘤组织学和边缘剂量是用SRS治疗的BM中局部衰竭 (LF) 的关键预测因素.
科学领域:
- 神经外科 神经外科
- 辐射瘤学 辐射瘤学
- 医学瘤学 医学瘤学
背景情况:
- 对于大脑转移 (BMs) 的立体射线外科手术 (SRS) 传统上使用剂量减少用于较大的瘤或先前照射.
- 降低剂量历来导致了低于最佳的局部控制 (LC).
- 现代的全身疗法可以在选择的BM中允许有效的低剂量SRS.
研究的目的:
- 评估局部控制 (LC) 和低剂量SRS对BMs的毒性.
- 在用低剂量SRS.治疗的BM中确定局部衰竭 (LF) 的预测因子.
- 在当代全身疗法背景下评估低剂量SRS的可行性.
主要方法:
- 在2014年至2021年期间,对102名患者进行了回顾性审查,其中包括688名BM患者.
- 低边际剂量SRS定义为≤14 Gy.
- 瘤控制与人口统计,临床和剂量计数据的相关性.
主要成果:
- 最常见的原发性癌症是肺癌 (47.1%) 和乳腺癌 (30.4%).
- 中位瘤体积为0.037cc,中位值剂量为14 Gy.
- 一年和两年的局部衰竭 (LF) 累计发病率分别为6%和12%.
- 较大的体积,黑色素瘤组织学和边缘剂量预测了LF.
- 一年和两年累计发生的不良辐射效应 (ARE) 是0.8%和2%.
结论:
- 低剂量SRS是一种可行的方法,可以在BM中实现可接受的LC.
- 瘤体积,黑色素瘤组织学和边缘剂量是LF的显著预测因素.
- 低剂量SRS可能对许多小瘤或邻近瘤,先前辐射或关键位置的瘤患者有价值,旨在维护LC和神经功能.
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