国际肿瘤学杂志

国际肿瘤学杂志››2023,Vol. 50››Issue (3): 138-143.doi:10.3760/cma.j.cn371439-20221214-00028

• 论著 •上一篇下一篇

基于直线加速器的分次立体定向放疗对小体积脑转移瘤的有效性及安全性

赵永瑞, 高莹, 陈怡东, 徐建堃()

  1. 首都医科大学宣武医院放射治疗科，北京 100053
  • 收稿日期:2022-12-14修回日期:2023-01-18出版日期:2023-03-08发布日期:2023-04-12
  • 通讯作者:徐建堃，Email： xjk_7563@163.com

Efficacy and safety of linear accelerator-based fractionated stereotactic radiotherapy for small volume brain metastases

Zhao Yongrui, Gao Ying, Chen Yidong, Xu Jiankun()

  1. Department of Radiation Oncology， Xuanwu Hospital， Capital Medical University， Beijing 100053， China
  • Received:2022-12-14Revised:2023-01-18Online:2023-03-08Published:2023-04-12
  • Contact:Xu Jiankun， Email： xjk_7563@163.com

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摘要：

目的探讨直线加速器的分次立体定向放疗（FSRT）对小体积脑转移瘤的有效性及安全性。方法回顾性分析2020年8月至2022年6月于首都医科大学宣武医院放射治疗科行FSRT的21例小体积脑转移瘤患者（共计45个病灶）的临床资料。小体积脑转移瘤定义为病灶直径≤3 cm且体积≤6 cm3，剂量分割方案为27~30 Gy/3 F或30~40 Gy/5 F。放疗3个月后评估FSRT对小体积脑转移瘤的疗效及放射性脑损伤发生率，并评估不同脑转移瘤的病灶直径、体积、剂量分割模式、生物等效剂量（BED）10以及病灶的分布部位亚组患者的放射性脑损伤发生率。结果24个病灶（53.33%，24/45）疗效评价完全缓解，13个病灶（28.89%，13/45）部分缓解，8个病灶（17.78%，8/45）病情稳定，脑转移瘤局部控制率为100%（45/45），客观缓解率为82.22%（37/45），颅内远处进展率为23.81%（5/21）。治疗及随访期间，共有7个病灶出现放射性脑损伤，放射性脑损伤发生率为15.56%（7/45），症状性放射性脑损伤发生率为11.11%（5/45）。亚组分析结果显示病灶直径为2~3 cm患者的放射性脑损伤发生率比病灶直径<2 cm的高，差异具有统计学意义[80.00%（4/5）比7.50%（3/40），χ2=12.69，P<0.001]；病灶体积为4~6 cm3患者的放射性脑损伤发生率比病灶体积<4 cm3的高，差异具有统计学意义[57.14%（4/7）比7.89%（3/38），χ2=7.49，P=0.006]；病灶剂量分割模式为27~30 Gy/3 F与30~40 Gy/5 F患者的放射性脑损伤发生率差异无统计学意义[9.52%（2/21）比20.83%（5/24），χ2=0.40，P=0.527]；病灶BED10<60 Gy与≥60 Gy患者的放射性脑损伤发生率差异无统计学意义[28.57%（2/7）比13.16%（5/38），χ2=0.22，P=0.641]；病灶位于相同脑叶与单发病灶或多发病灶但位于不同脑叶患者的放射性脑损伤发生率差异无统计学意义[28.57%（4/14）比9.68%（3/31），χ2=1.38，P=0.240]。结论基于直线加速器的FSRT对小体积脑转移瘤是有效的。病灶直径< 2 cm或体积<4 cm3的放射性脑损伤发生率较直径2~3 cm或体积4~6 cm3的脑转移瘤放射性脑损伤发生率低。

关键词:化放疗,放射外科手术,脑转移瘤,分次立体定向放疗

Abstract:

ObjectiveTo investigate the efficacy and safety of fractionated stereotactic radiotherapy （FSRT） based on linear accelerator for small volume brain metastases.MethodsA total of 21 patients with small volume brain metastases who received FSRT from August 2020 to June 2022 were enrolled as subjects， including 45 lesions. Small-volume brain metastases were defined as ≤3 cm in diameter and ≤6 cm3in volume， and the dose/fractionation scheme was 27-30 Gy/3 F or 30-40 Gy/5 F. Three months after radiotherpy，the efficacy of FSRT in small brain metastases and the incidence of radiation brain injury were evaluated， and the incidence of radiation brain injury in subgroup analysis was performed according to the diameter， volume， dose/fractionation scheme， biological effective dose （BED）10， and location of lesions.ResultsTwenty-four lesions （53.33%， 24/45） were evaluated as complete response， another 13 lesions （28.89%， 13/45） were evaluated as partial response， and in the remaining 8 lesions （17.78%， 8/45） were evaluated as stable disease. The local control rate was 100% （45/45）， the objective remission rate was 82.22% （37/45）， and the intracranial distant progression rate was 23.81% （5/21）. During the treatment and follow-up， there were 7 lesions （15.56%， 7/45） of radiation-induced brain injury， and the incidence of symptomatic radiation-induced brain injury was 11.11% （5/45）. Subgroup analysis showed that the incidence of radiation brain injury in the group with a lesion diameter of 2-3 cm was higher than that with a lesion diameter of <2 cm group， with a statistically significant difference [80.00% （4/5）vs.7.50% （3/40），χ2=12.69，P<0.001]； the incidence rate of radiation brain injury in the group with lesion volume of 4-6 cm3was higher than that with lesion volume of <4 cm3group， with a statistically significant difference [57.14% （4/7）vs.7.89% （3/38），χ2=7.49，P=0.006]. There was no significant difference in the incidence of radiation brain injury between the dose/fractionation scheme of lesions 27-30 Gy/3 F and 30-40 Gy/5 F [9.52% （2/21）vs.20.83% （5/24），χ2=0.40，P=0.527]. There was no significant difference in the incidence of radiation brain injury between the BED10<60 Gy and ≥60 Gy [28.57% （2/7）vs.13.16% （5/38），χ2=0.22，P=0.641]. There was no significant difference in the incidence of radiation brain injury between the lesions in the same lobe and the single or multiple lesions in different lobes [28.57% （4/14）vs.9.68% （3/31），χ2=1.38，P=0.240）.ConclusionFSRT based on linear accelerator is effective for small volume brain metastases. Brain metastases with the diameter <2 cm or volume <4 cm3are associated with a lower incidence of radiation brain injury than that of lesions with the diameter of 2-3 cm or volume of 4-6 cm3.

Key words:Chemoradiotherapy,Radiosurgery,Brain metastases,Fractionated stereotactic radiotherapy