電腦刀立體定位放射手術應用於脊椎腫瘤之治療

Application of CyberKnife Stereotactic Radiosurgery for Treatment of Spinal Tumors

龔煥文(Woon-Man Kung) ； 洪國盛(Kuo-Sheng Hung) ； 蔡若婷(Jo-Ting Tsai) ； 陳家媛(Chia-Yuen Chen) ； 林家瑋(Jia-Wei Lin) ； 邱文達(Wen-Ta Chiu) ； 張丞圭(Cheng-Kuei Chang)

《中華民國癌症醫學會雜誌》 23卷2期 (2007/06) Pp. 19-29

https://doi.org/10.6588/JCOS.2007.23.2.1

摘要

背景：
本報告將概述本院在臨床上運用非侵襲性電腦手術刀(CyberKnife)治療脊髓腫瘤的研究成果。
研究對象及方法：
所謂「立體定位放射手術」，是指將高劑量的輻射線對腫瘤直接照射，並將周邊正常組織所接受到的輻射劑量降到最低。CyberKnife 是一種無框架的放射手術裝置，運用機器控制的直線加速器及兩個垂直正交X光攝影機輔助顯影。本報告中的研究對象為2005年9月至2006年6月在市立萬芳醫院接受階段性放射手術的患者，計23名病患、27處病變組織：其中包括16處轉移病變及11處原發病變。每位患者分別依據腫瘤的位置加以評估，硬膜外腫瘤是以疼痛指數(VAS)來衡量、硬膜內髓外腫瘤則由McCormick級數及腫瘤大小的變化加以觀察評估。
研究結果：
追蹤病灶期間由一個月到十個月不等。追蹤期間，大部分病患的功能狀態都有進步，硬膜外腫瘤的患者的疼痛減輕；硬膜內髓外腫瘤患者的McCormick級數降低、腫瘤體積減小。使用CyberKnife進行手術，腫瘤覆蓋指數的範圍在89.45%到99.65%之間，處方劑量在71%到91%之間，均質性指標(Homogeneity index)的範圍在1.1到1.43之間，順形指數(ConformityIndex, CI)在1.14到1.87之間。其中一名患者在手術四星期後發生放射線治療引起的脊髓水腫及出血，在接受緊急減壓椎板切除術後已局部康復。兩位患者在追蹤期間過世。腫瘤體積大小在376到38,3099立方公厘之間，接受輻射劑量維持在1400到3000cGy之間，分次進行治療。
探討：
脊椎腫瘤患者接受CyberKnife階段性立體定位放射手術之後，功能狀態及生活品質皆有改善，可說是一種可行性高、安全又有效的治療方法。以此種介入性的放射手術治療脊椎腫瘤最大的好處是手術時間短、病症可在短時間內獲得改善、術後不常出現副作用。然而，後期的併發症仍須長期的觀察及評估。

關鍵字

電腦手術刀CyberKnife ； 脊椎腫瘤 ； 階段性立體定位放射手術

並列摘要

Background and Purpose
This report summarizes our clinical experience with CyberKnife radiosurgery as a noninvasive treatment for spinal tumors.
Methods
Stereotactic radiosurgery delivers a high dose of radiation to the tumor and minimizes the dose to the adjacent normal structures. CyberKnife is a frameless radiosurgery system with robot controlled linear accelerator and image guided by two orthogonal x-ray cameras. Data obtained from patients with spinal tumors who underwent CyberKnife radiosurgery at Municipal Wan-Fang hospital between September 2005 and June 2006 was analyzed. Twenty-three patients with twenty-seven lesions were treated. There were sixteen metastatic and eleven primary lesions detected. All patients treated with CyberKnife were assessed individually according to the location of the tumor; extradural lesions were assessed with the visual analog scale (VAS) pain scale, intradural-extramedullary lesions with the McCormick scale and intradural-intramedullary lesions with the McCormick scale combined with tumor volume change.
Results
The follow-up period ranged from one to ten months. Most patients experienced an improvement of functional status. Pain improved in patients with extradural lesions. Neurological improvements with decrease in McCormick scale occurred in patients with intradural-extramedullary lesions. Both McCormick scale and tumor volume decreased in patients with intradural-intramedullary lesions. Tumor coverage index ranges from 89.45% to 99.65%. Prescription isodose was between 71 to 91%. Homogeneity index ranges from 1.1 to 1.43. Conformity index ranges from 1.14 to 1.87. One patient experienced radiation-induced spinal cord swelling and bleeding four weeks after radiosurgery and received emergent decompressive laminectomy with partial recovery. Two patients expired. Tumor volume ranged from 376 to 383099mm^3. Tumor radiation dose was maintained at 1400 to 3000cGy divided into one to five fractions.
Conclusions
CyberKnife frameless stereotactic radiosurgery improves functional status and quality of life in patients with spinal tumors. It was found to be feasible, safe and effective. The major benefits of radiosurgical ablation of spinal lesions are short treatment time with rapid symptomatic response. Early adverse effects are infrequent. However, late complications require long-term follow-up.

並列關鍵字

CyberKnife ； spinal tumors ； stereotactic radiosurgery