手术靶向放射治疗与立体定向放射治疗：脑转移瘤切除腔的剂量比较。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-11-01 DOI:10.1016/j.brachy.2024.06.007

Tugce Kutuk , Rupesh Kotecha , Roberto Herrera , D Jay J. Wieczorek , Zachary W. Fellows , Vibha Chaswal , Alonso La Rosa , Vivek Mishra , Michael W. McDermott , Vitaly Siomin , Minesh P. Mehta , Alonso N. Gutierrez , Ranjini Tolakanahalli

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引用次数: 0

摘要

目的：将铯-131种子嵌入胶原瓦中进行手术靶向放射治疗（STaRT）是一种治疗复发性脑转移瘤的有效方法。本研究将 STaRT 计划对正常组织和靶组织的生物有效剂量（BED）与外照射放疗（EBRT）模式进行了比较：九名患者（n = 9）有 12 个切除腔（RC），他们接受了 STaRT（RC 边缘 5 mm 深度的累积物理剂量为 60 Gy），并使用 CyberKnifeⓇ (CK)、伽玛刀Ⓡ (GK) 和强度调制质子疗法 (IMPT) 进行了 SRT 方法（30 Gy，分 5 次进行）的重新计划。BED10Gy的D95%和D90%（BED10Gy95%和BED10Gy90%）与RC + 0至+ 5 mm扩展边缘的统计意义，以及与正常脑放射坏死风险相关的参数（V83Gy、V103Gy、V123Gy和V243Gy），均通过Wilcoxon-signed秩检验进行评估：对于 RC + 0 mm，START 的中位 BED10Gy 90%（90.1 Gy10，范围：64.1-140.9 Gy10）明显高于 CK（74.3 Gy10，范围：59.3-80.4 Gy10，p = 0.04）、GK（69.4 Gy10，范围：59.8-77.1 Gy10，p = 0.005）和 IMPT（49.3 Gy10，范围：49.0-49.7 Gy10，p = 0.003）。然而，对于 RC + 5 mm，STaRT 的中位 BED10Gy 90%（34.1 Gy10，范围：22.2-59.7 Gy10）分别显著低于 CK（44.3 Gy10，范围：37.8-52.4 Gy10）和 IMPT（46.6 Gy10，范围：45.1-48.5 Gy10），但与 GK（34.1 Gy10，范围：22.8-47.0 Gy10）无显著差异。与 STaRT（1.1 cc，范围：0.0-7.8 cc）相比，CK（11.7 cc，范围：4.7-20.1 cc）、GK（6.2 cc，范围：2.3-11.9 cc）和 IMPT（19.9 cc，范围：11.1-36.6 cc）的中位 V243Gy 明显更高（P < 0.01）：这项对比分析表明，与 EBRT 方法相比，STaRT 方法可以通过在距离 RC 边缘至少 3 mm 的范围内提供更高的放射剂量和等效或更高的 BED 来有效治疗复发性脑肿瘤。

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Surgically targeted radiation therapy versus stereotactic radiation therapy: A dosimetric comparison for brain metastasis resection cavities

PURPOSE

Surgically targeted radiation therapy (STaRT) with Cesium-131 seeds embedded in a collagen tile is a promising treatment for recurrent brain metastasis. In this study, the biological effective doses (BED) for normal and target tissues from STaRT plans were compared with those of external beam radiotherapy (EBRT) modalities.

METHODS

Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnife^Ⓡ (CK), Gamma Knife^Ⓡ (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED_10Gy (BED_10Gy95% and BED_10Gy90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V8_3Gy, V10_3Gy, V12_3Gy and V24_3Gy) to the normal brain were evaluated by a Wilcoxon-signed rank test.

RESULTS

For RC + 0 mm, median BED_10Gy 90% for STaRT (90.1 Gy₁₀, range: 64.1–140.9 Gy₁₀) was significantly higher than CK (74.3 Gy₁₀, range:59.3–80.4 Gy₁₀, p = 0.04), GK (69.4 Gy₁₀, range: 59.8–77.1 Gy₁₀, p = 0.005), and IMPT (49.3 Gy₁₀, range: 49.0–49.7 Gy₁₀, p = 0.003), respectively. However, for the RC + 5 mm, the median BED_10Gy 90% for STaRT (34.1 Gy₁₀, range: 22.2–59.7 Gy₁₀) was significantly lower than CK (44.3 Gy₁₀, range: 37.8–52.4 Gy₁₀), and IMPT (46.6 Gy₁₀, range: 45.1–48.5 Gy₁₀), respectively, but not significantly different from GK (34.1 Gy₁₀, range: 22.8–47.0 Gy₁₀). The median V24_3Gy was significantly higher in CK (11.7 cc, range: 4.7–20.1 cc), GK(6.2 cc, range: 2.3–11.9 cc) and IMPT (19.9 cc, range: 11.1–36.6 cc) compared to STaRT (1.1 cc, range: 0.0–7.8 cc) (p < 0.01).

CONCLUSIONS

This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches.

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来源期刊

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.