脑转移瘤的立体定向放射外科治疗24例报道

目的 探讨立体定向放射外科（ＳＲＳ）治疗脑转移瘤的效果。方法 以全脑放疗加ＳＲＳ或单用ＳＲＳ治疗２４例（３０病灶）脑转移瘤。结果 大多数病例在ＳＲＳ后１～２周获不同程度的症状改善,肿瘤反应率为８９％平均存活期为１０月。结论 ＳＲＳ是治疗小而边界清楚的脑转移瘤的有效手段,肿瘤控制率可达８０％以上,ＳＲＳ加全脑放疗可改善肿瘤控制率。ＳＲＳ亦可用以治疗放疗后复发的脑转移瘤。     

X线立体定向放射治疗脑转移瘤的疗效分析

目的观察立体定向放射手术治疗脑转移瘤的疗效。方法X线立体定向放射治疗脑转移瘤患者47例,采用10MV的直线加速器多个非共面弧旋转照射,肿瘤剂量为18～25Gy(平均22.1Gy)。40例患者在术后接受了肿瘤剂量30～40Gy的全脑放疗。结果中位生存期为11个月,1年生存率37.5%,疗后3个月的肿瘤控制率为90.7%,KPS≥70、原发肿瘤已控和无颅外转移患者的预后较好(P<0.05)。结论立体定向放射治疗脑转移瘤是安全和有效的。     

立体定向放射手术治疗脑转移瘤的新进展

立体定向放射手术（SRS）随着定位及计算机技术的飞速发展和大量临床经验的积累,现已扩展到治疗一定体积范围内的恶性肿瘤,尤其是脑转移瘤。恶性肿瘤脑转移的发生率一般文献报道为25％～30％,尸检发生率要比临床发生率高,约占颅内肿瘤的一半左右。脑转移患者预后差,常伴有不同程度的神经功能丧失,这成为死亡的主要原因。未治疗脑转移瘤的自然病程短,中位生存期仅1至2个月。大约60％～80％的脑转移瘤患者不适合或拒绝行外科手术,放疗成为首选治疗,但由于受正常胞组织放射耐受量的限制,放疗剂量不可能很高,而在这一方面SRS则有…     

全脑放疗联合立体定向分割放疗治疗脑转移瘤30例

[目的]探讨全脑放疗加立体定向分割放疗治疗脑转移瘤患者的疗效。[方法]30例1～4个脑转移瘤患者接受全脑放疗30~36Gy/（15~30f·3~3.5w）后加立体定向分割放疗25Gy/（5f·1周）（WBRT＋SRT组）。30例1～4个脑转移瘤患者接受单纯全脑放疗30Gy/（10f·2周）（WBRT组）。分析两组患者的1年局控率和1年生存率。[结果]WBRT＋SRT组和WBRT组1年局控率分别为76.3%、23.5%（P〈0.01）,1年生存率分别为46.7%、13.3%（P〈0.05）。两组均未出现严重毒副反应。[结论]全脑放疗加立体定向分割放疗（WBRT＋SRT）治疗脑转移瘤患者安全有效,可提高1～4个脑转移瘤病灶患者的1年局控率和1年生存率。     

立体定向放射外科治疗脑转移瘤

本文对脑转移瘤立体定向放射手射外科的文献进行总结，讨论了立体定向放射外科治疗脑转移瘤的适应证，治疗方法，治疗效果和并发症。     

脑转移瘤立体定向放射外科治疗

立体定向脑放疗放射外科(SRS)可治疗单发或多发脑转移瘤，与全脑放射治疗(WBRT)相比，能延长生存时间、提高生活质量。用于全身肿瘤控制或稳定、直径≤3．5cm单发脑转移瘤患者，具有与手术配合WBRT相似的疗效。SRS加WBRT与单纯SRS治疗相比，能提高颅内无进展生存期，但未能延长生存时间。脑转移瘤复发后SRS治疗能取得较好疗效。     

肺癌脑转移瘤的立体定向放射外科治疗

肺癌脑转移发生率较高 ,约 2 0 %～5 0 %。Ｅｒｉｃｓ等[1] 报道了 72 9例脑转移瘤患者 ,原发灶为肺癌者占 39% ,其中非小细胞肺癌为 2 4% ,小细胞肺癌为 15 % ,明显多于其他肿瘤。肺癌脑转移患者如未经治疗 ,其中位生存期仅 1个月。采用皮质激素治疗和全脑放疗 ,中位生存期可提高到 3～ 6个月[2 ] 。有报道称手术切除加全脑放疗与单用全脑放疗相比可显著提高中位生存期并改善功能情况[3] 。但近来的随机试验显示两者无显著差异[4 ] 。肺癌远处转移治愈的可能性很小。尽管采取了一些新的外科技术和方法 ,但单纯外科手术仍很难取得令人满意的…     

立体定向放射外科对脑转移瘤的治疗现状

脑转移瘤在肿瘤临床中是常见的.恶性肿瘤脑转移的发生率约为5%～30%.未经治疗的脑转移患者中位生存期仅为1个月,经传统全脑放射治疗后中位生存期达3～4个月.近来发展起来的立体定向放射外科(SRS)技术能更有效的控制脑转移瘤,把中位生存期提高到8～12个月.SRS是采用电离辐射、单次、大剂量集中照射颅内病灶,使病灶产生不同程度的放射损伤和其它放射性改变,避免常规开颅手术而达到治疗的目的,这种技术最早是由瑞典的著名神经外科医生Lesksell提出的.随着各种影像技术及电子计算机三维治疗计划系统的发展,使SRS技术更加完善.目前SRS主要有以广3种方法:(1)γ—刀:以~(60)Co为辐射源,通过球形准直器聚焦201个~(60)Co源射线于靶区.(2)X-刀:以电子直线加速器产生的高能X线为辐射源,通过若干(5～10个)非共面的等中心放射弧,聚焦X线于靶区.(3)质子刀:利用质子Bragg峰的特性,使质子的能量集中释放于靶区.质子刀的设备昂贵,难以广泛应用于临床,目前国内外常用X-刀及γ-刀实现SRS.     

手术放射手术和放疗治疗脑转移瘤疗效的比较

回顾性分析手术、立体定向放射手术和放疗治疗脑转移瘤的疗效。1991年1月至1995年12月,59例脑转移瘤分别采用手术(10例),放射手术(19例)和放疗(30例)治疗。手术组术后全脑照射40Gy,放射手术剂量20～30Gy(平均21.1Gy),放疗组全脑照射30～40Gy,然后缩野追加10～24Gy。手术组、放射手术组、放疗组的中位生存期分别为12.5个月、11.2个月、5.6个月;一年生存率分别为60％、47.4％、20％。手术和放射手术治疗脑转移的疗效相似(P=0.25),且明显好于常规放疗(P<0.05)。     

脑转移瘤立体定向放射外科治疗

立体定向脑放疗放射外科(SRS)可治疗单发或多发脑转移瘤,与全脑放射治疗(WBRT)相比,能延长生存时间、提高生活质量.用于全身肿瘤控制或稳定、直径≤3.5cm单发脑转移瘤患者,具有与手术配合WBRT相似的疗效.SRS加WBRT与单纯SRS治疗相比,能提高颅内无进展生存期,但未能延长生存时间.脑转移瘤复发后SRS治疗能取得较好疗效.     

35例胰腺癌立体适形放射治疗

目的：应用立体适形放射治疗技术治疗胰腺癌，评价其疗效和并发症。方法：35例胰腺癌患者给予立体适形放射治疗，每天1次，每次2Gy～3Gy，每周共5次，共计20次-35次；5个～8个共面或非共面适形固定野，总剂量60Gy～70Gy。结果：83．33％患者胸背部疼痛明显缓解；放疗后2个月～6个月复查CT，肿瘤缩小25％以上者60．00％；1年、2年生存率分别为77．14％、29．16％。结论：立体适形放射治疗胰腺癌，疗效较好，并发症少，是不能手术的患者的较好的治疗方式。     

Hypofractionated stereotactic radiotherapy for the treatment of brain metastases

BACKGROUND:

This retrospective review evaluated the efficacy and toxicity profiles of various dose fractionations using hypofractionated stereotactic radiotherapy (HSRT) in the treatment of brain metastases.

METHODS:

Between 2004 and 2007, 36 patients with 66 brain metastases were treated with HSRT. Nine of these subjects were excluded because of the absence of post‐treatment magnetic resonance imaging scans, resulting in 27 patients with a total of 52 lesions. Of these 52 lesions, 45 lesions were treated with whole‐brain radiotherapy plus a HSRT boost and 7 lesions were treated with HSRT as the primary treatment. The median prescribed dose was 25 grays (Gy) (range, 20 Gy‐36 Gy) with a median of 5 fractions (range, 4 fractions‐6 fractions) to a median 85% isodose line (range, 50%‐100%). The median follow‐up interval was 6.6 months (range, 0.9 months‐26.8 months).

RESULTS:

The median overall survival time was 10.8 months, and 66.7% of patients died of disease progression. After HSRT treatment of 52 brain lesions, 13 lesions demonstrated complete responses, 12 lesions demonstrated partial responses, 22 lesions demonstrated stable disease, and 5 lesions demonstrated progressive disease. Actuarial local tumor control rates at 6 months and 1 year were 93.9% and 68.2%, respectively. Maximum tumor dimension, concurrent chemotherapy, and a tumor volume <1 cc were found to be statistically significant factors for local tumor control. One patient had a grade 3 toxicity (according to National Cancer Institute Common Terminology Criteria for Adverse Events).

CONCLUSIONS:

HSRT provides a high level of tumor control with minimal toxicity comparable to single‐fraction stereotactic radiosurgery (SRS). The results of the current study warrant a prospective randomized study comparing single‐fraction SRS with HSRT in this patient population. Cancer 2009. © 2009 American Cancer Society.     

肺癌脑转移不同放射治疗方法的疗效分析

［目的］探讨不同放射治疗方法对肺癌脑转移的疗效。［方法］１７６例有病理学证实的肺癌脑转移患者分为４组：单纯全脑放疗组(WBRT)、全脑放疗加立体定向放射外科(WBRT＋SRS)，单纯立体定向放射治疗(SRT)，全脑放疗加立体定向放射治疗(WBRT＋SRT)。SRS治疗组，单次靶区平均周边剂量８Gy～２０Gy，总剂量２０Gy～３２Gy；SRT治疗组，单次靶区平均周边剂量２Gy～５Gy，总剂量２５Gy～６０Gy；WBRT组，１．８Gy～２Gy／次，总剂量３０Gy～４０Gy。［结果］４组的局部控制率分别为４７．１％、８７．７％、８６．５％、７８％；中位生存期分别为５．０、１１．０、１１．５、１０．０个月；局部无进展生存期分别为３．３３、８．３３、９．３３、７．６７个月；颅脑无新病灶生存期分别为４．１１、８．５７、９．０３、６．１２个月。单纯全脑放疗组死于脑转移的占５７．６％，较其他３组高。而全脑放疗加立体定向放射外科组的晚期放射反应的发生率为１２．２％，较其它组高。［结论］肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗。多发脑转移，全脑放疗加立体定向放射治疗(WBRT＋SRT)在提高生存率以及减少并发症方面优于其他治疗方法。     

48例肺癌脑转移瘤的放射治疗

４８例肺癌脑转移瘤放疗后总的症状缓解率为８７．５％。全脑照射２０￣３０Ｇｙ（Ａ组）、３１￣４０Ｇｙ（Ｂ组）以及３１－４０Ｇｙ＋缩野补充照射２０￣３０Ｇｙ（Ｃ组）的症状缓解率分别为９０．０％、９２．９％和９７．６％，三组间差异无统计学意义（Ｘ＾２＝１．９６ Ｐ＝０．３７５６）。Ａ、Ｂ、Ｃ三组的症状完全缓解率分别为４７．５％、７８．６％和８０．５％，Ａ组与Ｂ组、Ａ组与Ｃ组之间差异有统计学意义；Ｂ组与Ｃ     

Contemporary practice patterns of stereotactic radiosurgery for brain metastasis: A review of published Australian literature

There has been a shift in the management of brain metastasis (BM), with increasing use of stereotactic radiosurgery (SRS) and delaying/avoiding whole‐brain radiotherapy (WBRT), given the concern regarding the long‐term neurocognitive effect and quality of life impact of WBRT. It is, however, unclear as to the contemporary practice pattern and outcomes of SRS in Australia. We conducted a literature search in PubMed and MEDLINE using a series of keywords: ‘stereotactic’, ‘radiosurgery’ and ‘brain metastases’, limiting to Australian studies, which report on clinical outcomes following SRS. Eight studies – one randomized trial and seven retrospective cohort studies – were identified and included in this review. A total of 856 patients were included, with the most common primary tumour types being melanoma, lung cancer and breast cancer. Approximately half of the patients had solitary BM, while 7% had 10 or more BM lesions. SRS is not routinely given in combination with WBRT. The 6‐month intracranial control and 1‐year intracranial control following SRS were reported in the range of 67–87% and 48–82%, respectively, whereas the 1‐year overall survival and 2‐year overall survival were reported in the range of 37–60% and 20–36%, respectively. There are limited data reported on SRS‐related toxicities in all included studies. Overall, despite increasing use of SRS for BM, there is a low number of published Australian series in the literature. There is a potential role for establishing an Australian clinical quality registry or collaborative consortium for SRS in BM, to allow for systematic prospective data collection, and benchmarking of quality and outcomes of SRS.     

Questionnaire Survey of Treatment Choice for Breast Cancer Patients with Brain Metastasis in Japan: Results of a Nationwide Survey by the Task Force of the Japanese Breast Cancer Society

Objective: A nationwide survey was performed to investigate the currentpatterns of care for brain metastasis (BM) from breast cancerin Japan. Method: A total of 351 survey questionnaires were sent to communityor academic breast oncologists who were members of the JapaneseBreast Cancer Society as of December 2005. The questionnaireconsists of 40 multiple choice questions in eight categories. Results: Of 240 institutions sent survey questionnaires, 161 (67.1%)answered; 60% of institutions answered with ‘<5’patients with BM every year; almost half (83 of 161) screenedfor BM in asymptomatic patients; surgical resection was rarelyperformed, as ~75% of institutions (118 of 160 institutions)answered ‘none or one case of surgery per year’;27% (41 of 154) preferred stereotactic radiosurgery (SRS) overwhole-brain radiotherapy (WBRT) as the initial treatment inall cases, although ~70% (100 of 154) of them answered ‘dependon cases’. The preference for SRS over WBRT mainly dependson the impressions of breast oncologists about both safety (latenormal tissue damage and dementia in WBRT) and efficacy (betterlocal control by SRS). Eighty-one percent (117 of 144) of institutionsdid not limit the number of SRS sessions as far as technicallyapplicable. Conclusion: SRS is widely used as the first choice for BM from breast cancerin Japan. Considerable numbers of Japanese breast oncologistsprefer SRS over WBRT as the initial treatment for BM. A randomizedtrial comparing SRS and WBRT is warranted.     

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。