Linac-based hypofractionated stereotactic radiotherapy for metastases involving the brainstem

医学 毒性 脑干 放射治疗 核医学 放射外科 立体定向放射治疗 放射科 剂量分馏 养生 回顾性队列研究 外科 内科学
作者
Michael V. Ortiz,Joseph P. Herbert,Busha Hika,Gregory Biedermann,Leslie E. Phillips,Amelia Wexler,N. Scott Litofsky
出处
期刊:Journal of Clinical Neuroscience [Elsevier]
卷期号:98: 235-239
标识
DOI:10.1016/j.jocn.2022.01.030
摘要

The long-term efficacy and complications of hypofractionated stereotactic radiotherapy (hSRT) to metastases involving the brainstem are not well reported. Our objective is to review the results of metastases intrinsic to or abutting the brainstem treatedwith hSRT.Patients treated with hSRT in 5 fractions at our institution from 2016 to 2020 were retrospectively reviewed. Varian Eclipse v13.7 TPS was used for treatment planning. MRI images were fused with CT images acquired at the time of simulation, and contoured structures include the brainstem, the GTV, and a 2 mm margin was used to generate the PTV. MR imaging was performed at 3-month intervals. Survival was assessed at the last available follow-up; tumor control was assessed at 6 and 12 months and toxicity was assessed based on the Radiation Therapy Oncology Group grading system at regular follow-up. Twenty patients were treated with 5 fraction treatment dose plans ranging from 20 Gy - 31.25 Gy. GTV mean volume was 3.5 cc ± 4.3 cc (range 0.1 cc - 18.9 cc). The median overall survival was 6.5 months (range: 1 to 29 months). The twelve-month tumor control rate was 80%. Toxicity was generally mild, with only one patient demonstrating Grade 3 toxicity. Two patients had radiographic progression, but neither required surgical intervention. In our series, hSRT resulted in similar rates of survival, tumor control, and toxicity as compared with published single fraction series. Dose escalation of lesions adjacent to the brainstem can be considered and maybe more feasible with a hypofractionated regimen of 5 fractions.
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