56例NSCLC脑转移灶与海马距离及与海马保护状态下PCI的PTV低剂量区关系

doi:10.3760/cma.j.issn.1004-4221.2016.01.011

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (1089 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的探讨NSCLC脑转移患者海马保护状态下PCI (HA-PCI)的可行性。方法搜集2011—2014年间56例NSCLC脑转移患者资料,在T₁W1增强MRI上勾画脑转移病灶和海马,分析脑转移病灶与海马之间距离;并设计HA-PCI计划,分析病灶在海马周围PTV低剂量区域内的分布情况。结果 139个病灶无一累及海马,海马外放5、10 mm范围时分别有6个(4.3%)、18个(12.9%)病灶。HA-PCI计划PTV的D_50%、D_2%分别为25.6、27.1 Gy;海马D_mean、D_2%分别为7.4、9.9 Gy;海马外围0~5.0、5.1~10.0、10.1~15.0 mm区域D_50%分别为10.3、15.1、20.5 Gy。结论 HA-PCI理论上是可行的,但还需长期生存患者颅内失败模式来证实。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：海马保护, 全脑照射, 非小细胞肺癌, 脑转移

Abstract： Objective To investigate the feasibility of prophylactic cranial irradiation with hippocampal avoidance (HA-PCI) in non-small cell lung cancer (NSCLC). Methods The clinical data of 56 patients with brain metastases of NSCLC who were treated from 2011 to 2014 were collected. Brain metastases and the hippocampus were delineated on T₁W1 contrast-enhanced MRI, and the distance between brain metastases and the hippocampus was analyzed;an HA-PCI regimen was also developed, and the distribution of the metastases in planning target volume (PTV) low-dose regions around the hippocampus was analyzed. Results None of the 139 metastases involved the hippocampus. There were 6(4.3%) and 18(12.9%) metastases within 5 mm and 10 mm, respectively, outside the hippocampus. In the HA-PCI regimen, the D_50% and D_2% of PTV were 25.6 Gy and 27.1 Gy, respectively. D_mean and D_2% for the hippocampus were 7.4 Gy and 9.9 Gy, respectively;D_50% within 0-5.0 mm, 5.1-10.0 mm, and 10.1-15.0 mm outside the hippocampus was 10.3 Gy, 15.1 Gy, and 20.5 Gy, respectively. Conclusions HA-PCI may be feasible theoretically, but this needs to be confirmed by the intracranial failure pattern in patients with long-term survival.

Key words： Hippocampus avoidance Whole-brain radiotherapy Non-small cell lung cancer Brain metastases

收稿日期: 2015-01-04

基金资助:江苏省临床医学科技专项(BL2014040)

通讯作者: 顾文栋,Email:hony0428@126.com;裴红蕾,Email:jtw316@sina.com

引用本文:

. 56例NSCLC脑转移灶与海马距离及与海马保护状态下PCI的PTV低剂量区关系[J]. 中华放射肿瘤学杂志, 2016, 25(1): 42-45.

. Distance between brain metastases of non-small cell lung cancer and the hippocampus and its correlation with PTV low-dose regions in prophylactic cranial irradiation with hippocampal avoidance:an analysis of 56 patients[J]. Chinese Journal of Radiation Oncology, 2016, 25(1): 42-45.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2016.01.011 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2016/V25/I1/42

[1]Gore EM,Bae K,Wong SJ,et al. Phase Ⅲ comparison of prophylactic cranial irradiation versus observation in patients with locally advanced non-small-cell lung cancer:primary analysis of radiation therapy oncology group study RTOG 0214[J].J Clin Oncol,2011,29(3):272-278.DOI:10../JCO.2010.29.1609.
[2]Auperin A,Arriagada R,Pignon JP,et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group[J].N Engl J Med,1999,341(7):476-484.DOI:10../NEJM199908123410703.
[3]Li N,Zeng ZF,Wang SY,et al. Randomized phase Ⅲ trial of prophylactic cranial irradiation versus observation in patients with fully resected stage Ⅲ_A-N₂ non-small-cell lung cancer and high risk of cerebral metastases after adjuvant chemotherapy[J/OL].Ann Oncol,2014(Epub ahead of print).DOI:10../annonc/mdu567.
[4]Park HS,Decker RH,Wilson LD,et al. Prophylactic Cranial irradiation for patients with locally advanced non-small-cell lung cancer at high risk for brain metastases[J/OL].Clin Lung Cancer,2014(Epub ahead of print).DOI:10../j.cllc.2014.11.005.
[5]DeAngelis LM,Delattre JY,Posner JB.Radiation-induced dementia in patients cured of brain metastases[J].Neurology,1989,39(6):789-796.
[6]Chera BS,Amdur RJ,Patel P,et al. A radiation oncologist′s guide to contouring the hippocampus[J].Am J Clin Oncol,2009,32(1):20-22.DOI:10../COC.0b013e318178e4e8.
[7]Schindler MK,Bourland JD,Forbes ME,et al. Neurobiological responses to stereotactic focal irradiation of the adult rodent hippocampus[J].J Neurol Sci,2011,306(1-2):129-137.DOI:10../j.jns.2011.03.025.
[8]Gondi V,Pugh SL,Tome WA,et al. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (rtog 0933):a phase Ⅱ multi-institutional trial[J].J Clin Oncol,2014,32(34):3810-3816.DOI:10../JCO.2014.57.2909.
[9]Harth S,Abo-Madyan Y,Zheng L,et al. Estimation of intracranial failure risk following hippocampal-sparing whole brain radiotherapy[J].Radiother Oncol,2013,109(1):152-158.DOI:10../j.radonc.2013.09.009.
[10]Marsh JC,Herskovic AM,Gielda BT,et al. Intracranial metastatic disease spares the limbic circuit:a review of 697 metastatic lesions in 107 patients[J].Int J Radiat Oncol Biol Phys,2010,76(2):504-512.DOI:10../j.ijrobp.2009.02.038
[11]Wan JF,Zhang SJ,Wang L,et al. Implications for preserving neural stem cells in whole brain radiotherapy and prophylactic cranial irradiation:a review of 2270 metastases in 488 patients[J].J Radiat Res,2013,54(2):285-291.DOI:10../jrr/rrs085.
[12]Hippocampal contouring:a contouring Atlas for RTOG 0933[DB/OL][2015-01-02].http://www.rtog.org/LinkClick.aspx?fileticket=59vaU8vfgQc%3 d&tabid=338.
[13]Gondi V,Tolakanahalli R,Mehta MP,et al. Hippocampal-sparing whole-brain radiotherapy:a"how-to" technique using helical tomotherapy and linear accelerator-based intensity-modulated radiotherapy[J].Int J Radiat Oncol Biol Phys,2010,78(4):1244-1252.DOI:10../j.ijrobp.2010.01.039.
[14]van Kesteren Z,Belderbos J,van Herk M,et al. A practical technique to avoid the hippocampus in prophylactic cranial irradiation for lung cancer[J].Radiother Oncol,2012,102(2):225-227.DOI:10../j.radonc.2011.09.023.
[15]Ghia A,Tome WA,Thomas S,et al. Distribution of brain metastases in relation to the hippocampus:implications for neurocognitive functional preservation[J].Int J Radiat Oncol Biol Phys,2007,68(4):971-977.DOI:10../j.ijrobp.2007.02.016