電腦刀治療轉移性腦瘤之研究

The Treatment of Metastatic Brain Tumors with CyberKnife-A Preliminary Report

廖國興(Kuo-Hsing Liao) ； 林乾閔(Chien-Min Lin) ； 林家瑋(Jia-Wei Lin) ； 陳家媛(Chia-Yuen Chen) ； 邱文達(Wen-Ta Chiu) ； 蔡若婷(Jo-Ting Tsai)

《中華民國癌症醫學會雜誌》 23卷1期 (2007/03) Pp. 1-9

https://doi.org/10.6588/JCOS.2007.23.1.1

摘要

目的：轉移性腦瘤(Metastatic Brain Tumor, MBT)有多種之治療方式，包括手術切除、全腦放射線治療(Whole Brain Radiotherapy, WBRT)、立體定位放射線手術(Stereotactic Radiosurgery, SRS)及化學治療等。由於高準確性、病人配合度高以及對正常腦細胞的非必要輻射傷害較低，SRS在治療轉移性腦瘤上日漸重要。而電腦刀(CyberKnife, CK)為一新型、不需頭架固定之立體定位放射線手術方式。已有諸多報告探討以電腦刀治療顱內及顱外腫瘤之成效，但只有零星報告討論電腦刀對轉移性腦瘤的治療效果，為瞭解電腦刀對轉移性腦瘤的局部控制效果及有無照射副作用(Adverse radiation effect)，故從事此研究。 方法：本研究以2005年9月至2006年8月間，於台北醫學大學－萬芳醫院電腦刀治療中心，接受電腦刀治療的十位轉移性腦瘤病人為對象，進行病患基本資料、原發性惡性腫瘤、轉移性腦瘤體積及數目、電腦刀照射劑量、及腫瘤局部控制率等作分析統計。 結果：十位病人中有四位男性，六位女性，平均年齡為47.3歲，平均追蹤時間為5.3個月。十位病人共有33個轉移性腦病灶，腫瘤體積平均為7.48 ml, 所接受電腦刀之最大劑量平均為2024.98 cGy。術後三個月追蹤之腫瘤體積(n=13)平均為3.13 ml，良好反應率(good response rate)為77.8%；而術後六個月之腫瘤平均體積(n=6)為1.74 ml，良好反應率為83.3%。 結論：電腦刀為一新型、不需頭架固定之立體定位放射線手術方式。我們提出第一份本土性研究，分析十位轉移性腦瘤經電腦刀治療後之病人，證明電腦刀對轉移性腦病灶有良好、有效之局部控制且無明顯之照射後副作用。

關鍵字

轉移性腦瘤 ； 電腦刀 ； 立體定位放射線手術 ； 全腦放射線治療

並列摘要

Background
The treatments of metastatic brain tumor are multimodalities, such as surgical excision, whole brain irradiation, stereotactic radiosurgery, or chemotherapy. Nowadays, the stereotactic radiosurgery plays a critical role for the treatment of metastatic brain tumor because of the high accuracy, less radiation damage to normal brain tissue, and good compliance of patients. CyberKnife, newly developed frame-less stereotactic radiosurgery, is applied for brain tumors treatment widely. We presented our preliminary experience for treatment of metastatic brain tumors with CyberKnife in Taiwan.
Methods
From September 1st, 2005 to August 31st, 2006, ten patients with metastatic brain tumors were treated with CyberKnife in Taipei Medical University-Wanfang Hospital. Among them, Age, sex, tumor volume, radiation dose, histological types, and tumor-control rate were reviewed.
Results
The average age was 47.3 years (ranged 29.9 to 63.8 years). The male to female ratio was 2/3. The primary malignance included five lung cancers and five breast cancers. Four cases were solitary metastatic brain tumor while six cases were multiple intracranial foci. The mean follow up period was 5.3 months (range from 1.3 months to 12.0 months). Among total 33 lesions, the mean tumor volume was 7.48 ml, and the mean radiation dose (maximum dose) was 2024.98 cGy. The mean tumor volume in post-treatment 3 months (n=13) was 3.13 ml with 77.8% good response rate. The mean tumor volume in post-treatment 6 months (n=6) was 1.74 ml with 83.3% good response rate.
Conclusions
CyberKnife is a useful treatment modality for metastatic brain tumor. It provides frame-less and high accuracy stereotactic radiosurgery to control metastatic brain tumors. In our series, we demonstrated that CyberKnife had good local control rate for metastatic brain tumors without significant side effects. We believe that the CyberKnife could be applied more widely in the coming future, not only in neurosurgery but also in neuroncology.

並列關鍵字

Metastatic brain tumors ； CyberKnife ； Stereotactic radiosurgery ； Whole brain radiotherapy