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脑干转移瘤的伽玛刀放射外科治疗

发布时间:2019-07-08 浏览次数:

  《Journal of Neurooncology 》2019年 5月 24日在线发表美国Winograd E, Rivers CI, Fenstermaker R,等撰写的《The case for radiosurgery for brainstem metastases.》( doi: 10.1007/s15-y)

  挑战对脑干转移瘤患者预后存在普遍的悲观的认识,会让人使用全脑放射治疗以缓解症状,而不是使用立体定向放射外科治疗以明确控制和维持生存质量。作者的研究旨在通过单中心的回顾评价伽玛刀放射外科(GKRS)积极治疗脑干转移瘤的有效性和安全性。

  作者的研究纳入41例患者的45处病灶进行伽玛刀放射外科(GKRS)治疗。患者平均年龄为58.7岁,范围为22岁到82岁。客观计算肿瘤体积,通过影像学和临床数据评估治疗效果,并与放射外科反应相联系。

  作者发现,脑干转移瘤(BSM)诊断后平均生存期为11.6个月,范围为1.4 - 58.8个月。边缘剂量范围为12至20Gy。第一次随访中,11例(27%)患者病灶完全消失。第二次随访15例(37%),第三次随访19例(46%)患者完全消失。平均下来,在治疗后的首次随访中,肿瘤大小平均缩小64%。25例(61%)患者在接受放射外科治疗的同时接受全脑放疗(WBRT)治疗;16例(39%)仅接受放射外科治疗。两组总体生存率无显著性差异(p = 0.1324)。其中一例2.06 cm3桥脑肿瘤患者接受边缘剂量16 Gy照射,但无相关症状。一例患者接受贝伐单抗(Bevacizumab)®治疗伽玛刀放射外科治疗后所出现的放射性副反应(ARE),进行性但无症状的水肿,但治疗后水肿不受的控制的。

  脑干的位置不应妨碍对这些患者进行放射外科治疗。添加或排除使用全脑放疗(WBRT)应基于患者的临床进展,且在本研究的范围内似乎不影响总体生存率。由于更好的全身性系统治疗已提高了生存率,这些患者可以从使这种策略以更好地保存认知功能中获益。

  作者总结道,伽玛刀放射外科(GKRS)是一种安全、有效的治疗脑干转移瘤(BSM)的方法,在默认使用全脑放疗(WBRT)之前,应该选择放射外科治疗方法。尤其是对颅外疾病有限,且一般状况(KPS)较好的脑干转移瘤(BSM)患者,应该选择伽玛刀放射外科(GKRS),而不是全脑放疗()WBRT,正如我们所已经指出的,他们有长期生存的潜力。本文所描述的体积效应可以帮助作为伽玛刀放射外科治疗后所设置适当的指导方针。然而,相比脑干以外的脑转移瘤小鱼儿心水论坛。特别是针对最大剂量可能受到限制的脑干转移瘤(BSM),还需要更多的数据以创建更明确的肿瘤组织学标准和预期的体积变化。我们之前讨论过应该利用病灶体积而非病灶的数量来决定是使用伽玛刀放射外科(GKRS)还是全脑放疗(WBRT)治疗的重要性。这里我们再次建议应采用3D(三维)体积分析作为随访中的标准测量记录。

  \u300aJournal of Neurooncology \u300b2019\u5e74 5\u6708 24\u65e5\u5728\u7ebf\u53d1\u8868\u7f8e\u56fdWinograd E, Rivers CI, Fenstermaker R,\u7b49\u64b0\u5199\u7684\u300aThe case for radiosurgery for brainstem metastases.\u300b\uff08 doi: 10.1007\/s15-y\uff09

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