微创锁眼开颅和立体定向近距离治疗新发脑少转移瘤的前瞻性研究。

IF 3.1 2区 医学 Q2 CLINICAL NEUROLOGY
Journal of Neuro-Oncology Pub Date : 2025-12-01 Epub Date: 2025-06-07 DOI:10.1007/s11060-025-05077-y
Smruti Mahapatra, Laurel Seltzer, Neydin Osorio, Michelle Miller, Andrew Janssen, Raj Mitra, Joseph Keen, Clayton Smith, Marcus Ware
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引用次数: 0

摘要

转移性脑肿瘤(mbt)是最常见的颅内肿瘤,影响高达40%的癌症患者。传统的治疗方法,如全脑放疗(WBRT)和立体定向放射外科(SRS)有局限性,包括神经认知能力下降和潜在的肿瘤再生。微创锁眼开颅术(MIKC)和铯-131 (Cs-131)近距离治疗因其精度和减少副作用而提供了有希望的替代方案。这项前瞻性研究旨在评估MIKC联合Cs-131近距离放疗治疗新诊断的脑少转移瘤的安全性和有效性。方法:在2019年至2021年期间招募了21名新诊断的脑转移患者。术前采用T1 MRI加钆扫描计算肿瘤总体积(GTV)。微创开颅术切除这些肿瘤,然后植入Cs-131种子。术后影像学检查证实种子放置和切除。计算剂量学值(V100、V200、D90)。每两个月对患者进行为期两年的随访,以监测局部进展、功能结局和生活质量。主要终点是无局部进展,次要终点包括总生存期、功能结局、生活质量和治疗相关并发症。结果:术前肿瘤中位体积为10.65 cm3,术后肿瘤切除腔体积减小至6.05 cm3。剂量学分析显示中位V100覆盖率为93.2%,V200覆盖率为43.9%,D90覆盖率为89.8 Gy。1年局部进展自由(FFP)为91.67%,远处FFP为53.91%。研究结束时,5名患者仍然存活,中位生存期为5.9个月,持续时间可能受到同时发生的COVID-19大流行的影响。仅有1例局部复发,无放射性坏死病例。神经、功能和认知症状均有显著改善。结论:MIKC联合Cs-131近距离放疗可有效控制局部肿瘤,改善脑少转移患者的功能预后。需要更大规模的进一步研究来验证这些发现并完善治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A prospective study of minimally invasive keyhole craniotomy and stereotactic brachytherapy for new brain oligometastases.

Introduction: Metastatic brain tumors (MBTs) are the most common intracranial tumors, affecting up to 40% of cancer patients. Traditional treatments such as Whole Brain Radiotherapy (WBRT) and Stereotactic Radiosurgery (SRS) have limitations, including neurocognitive decline and potential tumor regrowth. Minimally invasive keyhole craniotomy (MIKC) and Cesium-131 (Cs-131) brachytherapy offer promising alternatives due to their precision and reduced side effects. This prospective study aims to evaluate the safety and efficacy of combining MIKC with Cs-131 brachytherapy in treating newly diagnosed brain oligometastases.

Methods: Twenty-one adults with newly diagnosed brain metastases were enrolled from 2019 to 2021. Preoperative T1 MRI with gadolinium was used to calculate the gross tumor volume (GTV). Minimally invasive craniotomies were performed with resection of these tumors, followed by the implantation of Cs-131 seeds. Postoperative imaging was conducted to verify seed placement and resection. Dosimetric values (V100, V200, D90) were calculated. Patients were followed every two months for two years to monitor local progression, functional outcomes, and quality of life. The primary endpoint was freedom from local progression, with secondary endpoints including overall survival, functional outcomes, quality of life, and treatment-related complications.

Results: The median preoperative tumor volume was 10.65 cm3, reducing to a resection cavity volume of 6.05 cm3 post-operatively. Dosimetric analysis showed a median V100 coverage of 93.2%, V200 of 43.9%, and D90 of 89.8 Gy. The 1-year local freedom from progression (FFP) was 91.67%, while the distant FFP was 53.91%. Five patients remained alive at the study's end, with a median survival duration of 5.9 months, a duration likely impacted by the concurrent COVID-19 pandemic. Only one patient experienced local recurrence, and no cases of radiation necrosis were observed. Significant improvements were seen in neurological, functional, and cognitive symptoms.

Conclusion: Combining MIKC with Cs-131 brachytherapy is effective for local tumor control and improving functional outcomes in patients with brain oligometastases. Further studies with larger cohorts are needed to validate these findings and refine treatment protocols.

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来源期刊
Journal of Neuro-Oncology
Journal of Neuro-Oncology 医学-临床神经学
CiteScore
6.60
自引率
7.70%
发文量
277
审稿时长
3.3 months
期刊介绍: The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.
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