立体定向放射治疗脊柱转移瘤疗效分析

目的观察立体定向放射治疗脊柱转移瘤的疗效与不良反应。方法应用全身伽玛刀治疗脊柱转移瘤24例,肿瘤组织照射剂量38.2~46.8 Gy,10~13分次,13~17天完成。结果放疗后疼痛完全缓解(CR)7例,部分缓解(PR)12例,轻微疗效(MR)2例,止痛有效率90.5%。骨转移灶完全消失3例,明显缩小13例,治疗后生活质量评分较治疗前明显改善,消化道反应和骨髓抑制等不良反应轻微。结论立体定向放射治疗脊柱转移瘤止痛效果迅速持久,能明显改善患者的生活质量,控制肿瘤效果满意,值得推广。     

脊柱转移瘤立体定向放射治疗研究进展

脊柱是恶性肿瘤发生骨转移的最常见部位之一。多年来,放疗在脊柱转移瘤患者中发挥重要作用。近年来,立体定向放射治疗（SBRT）成为治疗脊柱转移瘤的有效方法之一,分割方式分单次与多次分割。本文就已发表文献中脊柱转移瘤立体定向放射治疗单次与多次分割的适应证与禁忌证、治疗技术、剂量及疗效、脊髓安全剂量分析、局部失败模式分析等方面做一综述。     

立体定向放射治疗肝脏转移瘤的临床疗效

目的探讨立体定向放射(stereotactic body radiation therapy,SBRT)治疗肝脏转移瘤的临床疗效。方法回顾性分析2016年12月至2020年5月同济大学附属东方医院收治的43例肝脏转移瘤患者的临床资料。所有患者均采用4D⁃CT或呼吸门控技术进行CT模拟定位,共58个病灶接受SBRT治疗,总剂量为36~70 Gy,分割次数为5~10次,1天1次,1周5次。结果43例患者均顺利完成全程放疗,中位随访时间为15.6个月(范围:2.0~31.9个月)。2年总生存率、局部控制率和无进展生存率分别为55.4%、86.0%和5.9%。常见的Ⅰ~Ⅱ级不良反应为食欲减退(6例)、疲劳(6例)、骨髓抑制(3例)和肝脏疼痛(1例),未发现Ⅲ级及以上不良反应。EQ⁃5D⁃5L生活质量量表的平均效用得分为0.848(标准差=0.277)。结论立体定向放射治疗肝脏转移瘤局部控制率良好且不良反应较少,其远期疗效和安全性值得开展随机对照研究进一步探索。     

立体定向外科联合全脑放射治疗脑转移瘤疗效分析

肿瘤发生脑转移后，如果不进行有效地治疗，中位生存期仅为1个月。长期以来，尽管临床上给予了积极治疗，生存期有明显延长，但预后仍非常差。目前何种治疗方法最佳尚无明确定论。1975年Leksell教授采用通过高能射线聚焦一次性大剂量定向照射靶区治疗病灶并取得了成功，此即立体定向外科治疗（stereotatic radiosurgery，SRS）。近年来这一方法得到越来遗多地应用。但如何正确、合理地应用立体定向外科治疗，     

23例脑转移瘤的立体定向放射治疗疗效观察

我院于 2 0 0 0年 10月～ 2 0 0 2年 4月采有X刀立体定向放射外科 (stereotacticradiotherapytreatment,SRT)治疗 2 3例脑转移瘤 ,共 5 9个病灶 ,取得了较好的临床疗效 ,现报道如下。1　材料与方法1 1　一般资料　本组 2 3例脑转移瘤病人 ,其中男性 10例 ,女性 13例。年龄 30～ 73岁 ,平均 5 6岁。 7例为单发 ,16例为多发 ,最多者 5个病灶 ,共 5 9个病灶。1 2　治疗方法　治疗系统应用医科达 6MSli-precise直线加速器和STAR - 10 0 0三维治疗计划系统 (大恒公司产品 )。治疗前采用胶片曝光法进行检验 ,机械误差在± 0 5mm以内。对脑转…     

立体定向放射治疗肺转移瘤八例

 目的 观察立体定向放射治疗（FSRT）对肺转移瘤的疗效。方法 8例患者共41个肺转移瘤病灶分别行FSRT，参考剂量曲线为90 % ~ 95 %，计划靶区（PTV）≤30 mm、30 ~ 40 mm、≥40 mm者，分别放疗DT 20 Gy／1次、30 Gy／2次、40 Gy／4次。结果 1 ~ 3个月复查，肺转移瘤完全缓解（CR）率100 %，其中3例（37.5 %）出现Ⅰ级放射性肺炎。结论 FSRT对肺转移瘤是一种有效的治疗方法。     

立体定向放疗及放射性粒子植入治疗脊柱转移瘤的研究进展

在所有肿瘤患者的疾病进展过程中,会有10%的患者发生脊柱转移。脊柱立体定向放疗（stereotac-tic radiotherapy,SRT）和放射性粒子植入术是治疗脊柱转移瘤的新兴方法。这两种方法本质上都是通过提高脊柱转移瘤受照剂量同时降低正常组织和危及器官受量并取得良好治疗效果的新技术。本文旨在阐述两种放疗新技术在治疗脊柱转移瘤的研究进展。     

腹主动脉旁转移瘤立体定向放射治疗的临床观察

目的：观察立体定向放射治疗对腹主动脉旁转移瘤的治疗作用。方法：采用立体定向放射治疗腹主动脉旁转移瘤患者31例,γ射线立体定向放射治疗（γ-刀）20例,X射线立体定向放射治疗（X-刀）11例。γ-刀选择50%剂量曲线DT2.8-4.5Gy,3f/w,8-10f。X-刀选择90%剂量曲线,DT3.0-4.5Gy,3f/W,8-10f。结果：治疗后1年CT瘤体缩小率占62.6%。治疗后腹痛不同程度减轻,治疗1周后减轻19例,占61.29%,治疗后2-3周疼痛症状减轻27例,占87.09%。彩色多普勒血流显像（COFI）肿块周边未见明显血流信号10例,占32.25%,血供减少或散在血流信号者17例,占54.83%,仍有丰富血流信号4例,占12.90%。所有病人治疗过程顺利,无血压下降及休克发生。结论：立体定向放射治疗腹主动脉旁转移瘤是一种安全、有效的方法。     

腹主动脉旁转移瘤立体定向放射治疗的临床观察

目的:观察立体定向放射治疗对腹主动脉旁转移瘤的治疗作用。方法:采用立体定向放射治疗腹主动脉旁转移瘤患者31例,γ射线立体定向放射治疗(γ-刀)20例,X射线立体定向放射治疗(X-刀)11例。γ-刀选择50%剂量曲线DT2.8~4.5Gy,3f/w,8~10f。X-刀选择90%剂量曲线,DT3.0~4.5Gy,3f/W,8~10f。结果:治疗后1年CT瘤体缩小率占62.6%。治疗后腹痛不同程度减轻,治疗1周后减轻19例,占61.29%,治疗后2~3周疼痛症状减轻27例,占87.09%。彩色多普勒血流显像(COFI)肿块周边未见明显血流信号10例,占32.25%,血供减少或散在血流信号者17例,占54.83%,仍有丰富血流信号4例,占12.90%。所有病人治疗过程顺利,无血压下降及休克发生。结论:立体定向放射治疗腹主动脉旁转移瘤是一种安全、有效的方法。     

Whole Brain Radiotherapy Combined with Stereotactic Radiotherapy Versus Stereotactic Radiotherapy Alone for Brain Metastases: a Meta-analysis

Aim: This study was to evaluate the effect of whole brain radiation (WBRT) combined with stereotacticradiotherapy (SRS) versus stereotactic radiotherapy alone for patients with brain metastases using a metaanalysis.Materials and Methods: We searched PubMed, EMBASE, Cochrane Library from their inceptionup to October 2013. Randomized controlled trials involving whole brain radiation combined with stereotacticradiotherapy versus stereotactic radiotherapy alone for brain metastases were included. Statistical analyseswere performed using RevMan5.2 software. Results: Four randomized controlled trials including 903 patientswere included. The meta-analysis showed statistically significant lowering of the local recurrence rate (OR=0.29,95%CI: 0.17~0.49), new brain metastasis rate (OR=0.45, 95%CI: 0.28~0.71) and symptomatic late neurologicradiation toxicity rate (OR=3.92, 95%CI: 1.37~11.20) in the combined group. No statistically significant differenceexisted in the 1-year survival rate (OR=0.78, 95%CI: 0.60~1.03). Conclusions: The results indicate that wholebrain radiotherapy combined with stereotactic radiotherapy has advantages in local recurrence and new brainmetastasis rates, but stereotactic radiotherapy alone is associated with better neurological function. However, asthe samples included were not large, more high-quality, large-sample size studies are necessary for confirmation.     

Whole Brain Radiotherapy Combined with Stereotactic Radiosurgery versus Stereotactic Radiosurgery Alone for Brain Metastases

Background: The aim of this study was to evaluate the effect of whole brain radiotherapy (WBRT) combined with streotactic radiosurgery versus stereotactic radiosurgery (SRS) alone for patients with brain metastases. Materials and Methods: This was a retrospective study that evaluated the results of 46 patients treated for brain metastases at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Radiation Oncology Department, between January 2012 and January 2015. Twenty-four patients were treated with WBRT+SRS while 22 patients were treated with only SRS. Results: Time to local recurrence was 9.7 months in the WBRT+SRS arm and 8.3 months in SRS arm, the difference not being statistically significant (p= 0.7). Local recurrence rate was higher in the SRS alone arm but again without significance (p=0,06). Conclusions: In selected patient group with limited number (one to four) of brain metastases SRS alone can be considered as a treatment option and WBRT may be omitted in the initial treatment.     

Fractionated Stereotactic Radiotherapy using CyberKnife for the Treatment of Large Brain Metastases: A Dose Escalation Study

AimsTo evaluate the toxicity and efficacy of fractionated stereotactic radiotherapy (FSRT) with doses of 18–30 Gy in three fractions and 21–35 Gy in five fractions against large brain metastases.Materials and methodsBetween 2005 and 2012, 61 large brain metastases (≥2.5 cm in maximum diameter) of a total of 102 in 54 patients were treated with FSRT as a first-line therapy. Neurological symptoms were observed in 47 of the 54 patients before FSRT. Three fractions were applied to tumours with a maximum diameter ≥2.5 cm and <4 cm, and five fractions were used for brain metastases ≥4 cm. After ensuring that the toxicities were acceptable (≤grade 2), doses were escalated in steps. Doses to the large brain metastases were as follows: level I, 18–22 Gy/three fractions or 21–25 Gy/five fractions; level II, 22–27 Gy/three fractions or 25–31 Gy/five fractions; level III, 27–30 Gy/three fractions or 31–35 Gy/five fractions. Level III was the target dose level.ResultsOverall survival rates were 52 and 31% at 6 and 12 months, respectively. Local tumour control rates of the 102 total brain metastases were 84 and 78% at 6 and 12 months, respectively. Local tumour control rates of the 61 large brain metastases were 77 and 69% at 6 and 12 months, respectively. Grade 3 or higher toxicities were not observed.ConclusionsThe highest dose levels of 27–30 Gy/three fractions and 31–35 Gy/five fractions seemed to be tolerable and effective in controlling large brain metastases. These doses can be used in future studies on FSRT for large brain metastases.     

肺癌脑转移的立体定向放疗

脑转移是癌症患者的主要转移部位,而肺癌是最常见的脑转移的原发病。对于脑转移患者,仅给予最佳支持治疗或内科治疗,中位生存期只有1~2个月,使用全脑放疗、立体定向放疗和手术后,患者生存期明显延长,但对于寡转移和多发转移患者,其治疗策略不同,同样对于如何选择不同的治疗方法,有必要进一步探讨。在延长患者生存期的基础上,尽量保存认知功能同样重要。     

Whole Brain Radiotherapy Versus Stereotactic Radiosurgery in Poor-Prognosis Patients with One to 10 Brain Metastases: A Randomised Feasibility Study

AimsA significant proportion of patients with brain metastases have a poor prognosis, with a life expectancy of 3–6 months. To determine the optimal radiotherapeutic strategy for brain metastases in this population, we conducted a randomised feasibility study of whole brain radiotherapy (WBRT) versus stereotactic radiosurgery (SRS).Materials and methodsPatients with a life expectancy of 3–6 months and between one and 10 brain metastases with a diameter ≤4 cm were enrolled at six Canadian cancer centres. Patients were randomly assigned (1:1) to receive either WBRT (20 Gy in five fractions) or SRS (15 Gy in one fraction). The primary end point was the rate of accrual per month. Secondary feasibility and clinical end points included the ratio of accrued subjects to screened subjects. This trial is registered with ClinicalTrials.gov (number NCT02220491).ResultsIn total, 210 patients were screened to enrol 22 patients into the trial; 20 patients were randomised between the two arms. Two patients did not receive treatment because one patient died and another patient withdrew consent after being enrolled. Patients were accrued between January 2015 and November 2017; the accrual rate was 0.63 patients/month. The most common reasons for exclusion were anticipated median survival outside the required range (n = 40), baseline Karnofsky Performance Score below 70 (n = 28) and more than 10 brain metastases (n = 28). The median follow-up was 7.0 months and the median survival was 7.0 months for all patients in the trial. The median intracranial progression-free survival was 1.8 months in the SRS arm and 9.2 months in the WBRT arm. There were five grade 3+ toxicities in the SRS arm and one grade 3+ toxicity in the WBRT arm; no grade 5 toxicities were observed. The cumulative rates of retreatment were 40% in the SRS arm and 40% in the WBRT arm.ConclusionsA randomised trial evaluating WBRT versus SRS in patients with one to 10 metastases and a poor prognosis is feasible. A slower than expected accrual rate and difficulties with accurate prognostication were identified as issues in this feasibility study. A larger phase III randomised trial is planned to determine the optimal treatment in this patient population.