分割体积调节弧线疗法(FVMAT)治疗少转移性脑瘤

Onco Pub Date : 2023-02-02 DOI:10.3390/onco3010004
C. Yeh, Peng-An Lai, Fang-Hui Liu, Chin-Chiao He
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引用次数: 0

摘要

颅内转移在成年癌症患者中非常常见,总发病率约为10-40%。在成人中最常见的原发性肿瘤是肺癌和乳腺癌癌症。脑转移预示着严重的预后,中位生存期为6-12个月。传统上,他们通过姑息治疗和全脑放射治疗(WBRT)进行治疗。WBRT是控制脑转移的有效方法,减少皮质类固醇用于控制肿瘤相关水肿,并有可能提高总生存率;然而,WBRT被发现与严重的神经认知退化有关,这种不良反应(AE)遵循双相模式,从治疗后4个月左右的短暂精神功能下降开始,慢慢导致数月至数年后的不可逆转的神经损伤。有证据表明,WBRT会对海马体造成辐射损伤,进而导致神经认知功能(NCF)下降。体积调制电弧疗法(VMAT)是一种相对较新的图像引导放射治疗方法,可同时有效地治疗多发性脑转移,神经认知后遗症较少。对18例癌症局限性(≤5例脑肿瘤)或少转移性脑肿瘤患者进行了空间分割VMAT技术治疗,总剂量为30 Gy,分为10个部分,平均随访1年后,患者耐受了VMAT治疗,无放射性神经毒性。局部控制率为84%,这19名患者的中位生存期为11.3个月(范围:9.1–22.4个月)。总之,VMAT是一种安全有效治疗脑少转移瘤的合适技术。
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Fractionated Volumetric Modulated Arc Therapy (FVMAT) for Oligometastatic Brain Tumor
Intracranial metastasis is very common in adult cancer patients with an overall incidence of approximately 10–40%. The most common primary tumors responsible for this in adults are lung and breast cancer. Brain metastasis signifies a grave prognosis, with a median survival of 6 to 12 months. They are traditionally managed with palliative care and whole brain radiotherapy (WBRT). WBRT was an effective method to control brain metastases, decreasing corticosteroid use to control tumor-associated edema, and potentially improving overall survival; however, WBRT was found to be associated with a serious neurocognitive degeneration, this adverse effect (AE) follows a biphasic pattern beginning with a transient decline in mental functioning at around 4 months post-treatment, slowly leading to an irreversible neurologic impairment from months to years later. Evidence supports that WBRT can cause radiation injury to the hippocampus, which in turn will lead to a decline in neurocognitive function (NCF). Volumetric modulated arc therapy (VMAT) is a relatively new type of image-guided radiotherapy that treats multiple brain metastasis simultaneously and efficiently with less neurocognitive sequelae. Eighteen cancer patients with limited (≤5 brain tumors) or oligometastatic brain tumor were treated with a spatially fractionated VMAT technique for a total dose of 30 Gy in 10 fractions, the patients tolerated the VMAT treatment with no radiation-induced neurologic toxicities after a mean follow-up of 1 year. Local control rate was 84%, and the median survival for these 19 patients was 11.3 months (range: 9.1–22.4 months). In conclusion, the VMAT is a suitable technique that is a safe and effective treatment for brain oligometastases.
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