CAJ | 학술논문

目的回顾性分析射波刀(Cyberknife)治疗脑转移瘤临床疗效.方法搜集2007年前1年天津肿瘤医院资料完整、射波刀治疗的脑转移病例40例,其中原发灶为肺癌27例、乳腺癌4例、消化道肿瘤4例、肾癌1例、原发灶不明4例.脑转移病灶共计68个,最大直径0.4～7.5 cm,平均1.9cm.在脑转移发现时,35例患者原发病经手术或化疗达到部分缓解或者稳定状态.射波刀治疗以计划靶体积几何中心为射野等中心及剂量归一点,通过数百个方向的射线束照射,使得80%等剂量面必须包括95%以上计划靶体积.采用低分割照射5～25Gy/次,1～5次,总剂量18～36Gy.结果失访2例,随访率为95%.射波刀治疗后1周评价临床症状改善有效率为90%(36例),3个月后复查颅脑强化CT或MRI后的病灶治疗有效(CR+PR+SD)率为94%(64/68).3个月局部控制率、1年生存率分别为78%(53/68)、68%(27例).在原病灶范围以外出现新发病灶14例(35%);新发病灶与年龄、是否行全脑放疗、肿瘤数目、肿瘤最大直径、射波刀单次治疗剂量、治疗次数和总治疗剂量等因素无关.结论单纯射波刀作为脑转移首程治疗临床效果较好.
목적 회고성분석사파도(Cyberknife)치료뇌전이류림상료효.방법 수집2007년전1년천진종류의원자료완정、사파도치료적뇌전이병례40례,기중원발조위폐암27례、유선암4례、소화도종류4례、신암1례、원발조불명4례.뇌전이병조공계68개,최대직경0.4～7.5 cm,평균1.9cm.재뇌전이발현시,35례환자원발병경수술혹화료체도부분완해혹자은정상태.사파도치료이계화파체적궤하중심위사야등중심급제량귀일점,통과수백개방향적사선속조사,사득80%등제량면필수포괄95%이상계화파체적.채용저분할조사5～25Gy/차,1～5차,총제량18～36Gy.결과 실방2례,수방솔위95%.사파도치료후1주평개림상증상개선유효솔위90%(36례),3개월후복사로뇌강화CT혹MRI후적병조치료유효(CR+PR+SD)솔위94%(64/68).3개월국부공제솔、1년생존솔분별위78%(53/68)、68%(27례).재원병조범위이외출현신발병조14례(35%);신발병조여년령、시부행전뇌방료、종류수목、종류최대직경、사파도단차치료제량、치료차수화총치료제량등인소무관.결론 단순사파도작위뇌전이수정치료림상효과교호.
Objective To retrospectively analyze clinical outcomes of brain metastases treated with Cyberknffe. Methods From Aug. 2006 to Aug. 2007, 40 patients with brain metastases treated with Cy-berknife in Tianjin Cancer Hospital were included. Totally 68 brain metastatic lesions were treated. The maximal diameter was 0.4 -7.5 cm (average 1.9 cm). The primary tumor of 35 patients was partial re-ponse or stable to the previous treatment at the diagnosis of brain metastasis. The geometric center of target volume was set as the isocenter and the nominal standard dose point. More than 95% target volume was cov-ered by 80% isodose surface. Hypofractionated radiation was 18 -36 Gy given in 1 -5 fractions of 5 -25 Gy. Results The Follow-up rate was 95%. The clinical symptom remission rate (including complete and partial remission) at one week after Cyberknife treatment was 90% (36/40). The therapeutic effective rate (CR + PR + SD) was 94% (64/68) after three months follow-up, which was evaluated by contrast-en-hanced CT or MRI. The 3-month local control and 1-year survival rates were 78% (53/68) and 68% (27/40). New brain metastatic lesions outside the radiation field occurred in 14 patients within 3 months, which was independent of age, whole brain irradiation, number or maximal diameter of original lesions, frac-tion dose, frequency or total dose of Cyberknife treatment. Conclusions Cyberknife, used as the primary treatment of brain metastases, can achieve good clinical outcomes.