Whole Brain Radiotherapy Followed by Boost to Individual Brain Metastases: A Case Report of Radiotherapy for Disseminated Brain Metastases Using Tomotherapy

全腦照射合併個別瘤塊追加照射以治療散布型腦轉移腫瘤：導航螺旋刀的病例報告

吳樂榮(Le-Jung Wu) ； 李星怡(Hsing-Yi Lee) ； 熊佩韋(Pei-Wei Shueng)

《放射治療與腫瘤學》 15卷3期 (2008/09) Pp. 249-256

https://doi.org/10.6316/TRO/200815(3)249

摘要

過去經驗及文獻報告，並未提及對散佈型腦轉移的病患採取全腦照射合併個別癌塊追加照射。原因可能包括技術上的困難，理論上散佈型腦轉移代表著極差的預後，及證據的缺乏。本病例報告即在報導我們利用導航螺旋刀治療一位因散佈型腦轉移（40個以上的癌塊）接受積極腦部照射病患的經驗。該女性為非小細胞癌病患，年齡44歲，在化療後腫瘤獲得數月控制後，出現腫瘤惡化跡象且併發腦部散佈轉移而導致腦壓升高症狀。由於其身體狀況尚佳，故採取積極腦部照射，冀望能給予較好的腦部控制，能順利完成援救化療。在經過15分次共30 Gy的全腦照射後，腦部水腫及神經症狀有明顯改善。全腦照射完三周後又接受13分次共26 Gy（大癌塊）及20 Gy（小癌塊）的個別癌塊的追加照射。治療過程順利並達到極佳的緩解作用且未造成明顯副作用。物理分析顯示導航螺旋刀有極佳的隨形治療能力及閃避重要正常器官結構的能力。

關鍵字

全腦照射 ； 轉移 ； 導航螺旋刀

並列摘要

There is no report up to date about treating disseminated brain metastases using whole brain radiotherapy followed by individual tumor boost. Technical difficulty, expected dismal prognosis, and lack of supporting evidences are possible reasons contributing to the lack of attention paid to this matter. This report may be a first on an aggressive brain radiation for symptomatic disseminated brain metastases, more than 40 tumor foci, using tomotherapy. The patient in question is a 44 year-old lady with advanced nonsmall cell lung cancer. Symptomatic disseminated brain metastases concurrent with progression of intrapulmonary disease developed after months of remission achieved by primary chemotherapy. Because of her relative young age and good performance status, an aggressive brain radiation was performed in a hope to deliver a better intracranial control during the period of ensuing salvage chemotherapy. A whole brain radiotherapy (WBRT) of 30 Gy in 15 fractions was delivered first and achieved a good palliative effect of ameliorating her brain edema and reducing the tumor sizes. A sequential tumor boost to all observable tumor foci was delivered three weeks after WBRT to a total dose of 56 Gy for two large masses or 50 Gy for other small masses, respectively, without incurring significant toxicity. The treatment to the patient is quite successful, taking into consideration of its good palliative effects as well as low toxicity. The physic profile showed that tomotherapy is good at delivering a highly conformal therapy to targets while avoiding critical structures, e.g. eyes.

並列關鍵字

Whole brain radiotherapy ； Metastases ； Tomotherapy