Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Preliminary Results of Fractionated Stereotactic Radiotherapy for Benign Brain Tumors

양성 뇌종양에 대한 분할 정위 방사선치료의 예비 결과

  • Choi, Byung-Ock (Department of Therapeutic Radiology, Cathoiic University Medical College) ;
  • Kang, Ki-Mun (Department of Therapeutic Radiology, Gyeongsang National University College of Medicine)
  • 최병옥 (가톨릭대학교 의과대학 치료방사선과학교실) ;
  • 강기문 (경상대학교 의과대학 치료방사선과학교실)
  • Published : 2003.03.01
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Abstract

Purpose : To evaluate the role of fractlonated sterotactic radiotherapy (FSRT) in the management of benign brain tumors, we reviewed the clinical, and radiographic responses of patients treated. Methods and Materials : Between March 1995 and March 2002, 36 patients with benign brain tumors were treated by FSRT. The pathological diagnoses consisted of pituitary adenomas (12 patients), cranio-pharyngiomas (5 patients), meningiomas (10 patients), and acoustic neurinomas (9 patients). Radiotherapy doses of 25 to 35 Gy (3~6 Gy/fraction, 5~10 fractions) were prescribed to the 85~90% isodose line, depending upon the location, size and volume of the tumors. The median clinical and radiographical follow up periods were 31 (range, 2~74) and 21 (range, 4~56) months, respectively. Results : In the 35 patients that could be evaluated for their clinical response, 13 (37.1%) were considered improved, 16 (45.7%) stable and 6 (17.2%) worse. Of the 33 patients who had radiographic studies, tumor shrinkage was noted in 17 (51.5%), tumor stabilization in 13 (39.4%), and tumor progression in 3 (9.1%). Of the 17 tumor shrinkage patients, 7 (21.2%) showed a complete response. Acute radiation-induced complications occurred iin 11 (30.6%) patients. Conclusions : FSRT is considered a safe and effective treatment method for begin brain tumors, but large numbers of patients, with relatively long follow-up periods are needed to assess the exact role or effect of FSRT.

목적 : 양성 뇌종양에 대하여 분할 정위 방사선치료를 시행한 후의 임상 경과 및 방사선 반응 등을 추적하여 그 효과를 평가하고자 하였다. 대상 및 방법 : 1996년 3월부터 2002년 3월까지 양성 뇌종양으로 진단 받고 분할 정위 방사선치료를 받았던 36례를 대상으로 분석을 하였다. 대상 환자의 종양은 뇌하수체 선종 12례, 두개인두종 5례, 수막종 10례, 청신경초종 9례 이었다. 방사선치료는 종양의 위치, 종류, 크기에 따라 5~10회 분할 치료로 85~90%의 등선량 곡선에 25~35 Gy까지 조사하였다. 임상 추적관찰 기간은 2~74개월(중앙값 31개월)이었고, 방사선 추적 관찰 기간은 4~56개월(중앙값 21개 월)이었다. 결과 : 임상 증상이 있었던 35례 중 분할 정위 방사선치료 후 임상 증상의 호전은 13례(37.1%)에서 보였으며, 16례 (45.7%)에서 증상의 변화가 없었고 증상의 악화는 6례(17.2%)에서 관찰되었다. 뇌신경장애를 동반한 28례 중 7례(25%)에서 증상 개선을 보였다. 추적 방사선 검사를 시행한 33례 중 17례(51.5%)에서 종양 크기의 감소를 보였으며, 그 중 7례(21.2%, 뇌하수체 선종-2, 두개인두종-3, 수막종-1, 청신경초종-1)는 종양의 완전 소실을 보였다. 13례(39.4%)에서 종양 크기의 변화가 없었고, 3례(9.1%)는 종양 크기의 진행을 나타내었다. 급성 부작용은 11례(30.6%)에서 관찰되었다 결론 : 양성 뇌종양의 분할 정위 방사선치료는 심각한 부작용 없이 시행할 수 있는 안전하고 효과적인 치료법이었다. 그러나, 정확한 역할에 대해서는 좀 더 많은 환자와 장기간의 추적관찰이 필요할 것으로 사료되었다.

Keywords

References

  1. Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 1951;102:316-319
  2. Eric J, Hall EJ. Radiobiology for the radiologist. 5th ed. Philadelphia, PA. Lippincott Co. 2000;397-398
  3. Benedict SH, Lin PS, Zwicker RD, et al. Stereotactic radiosurgery : Relative biological effect of continuos versus inter- mittent radiation exposures. Radiat Oncol Invest 1995;2:219-223 https://doi.org/10.1002/roi.2970020504
  4. Fabricant JI, Lyman JT, Hosobuchi Y. Stereotactic heavy ion beam Bragg peak radiosurgery for intracranial vascular disorders. Br J Radiol 1984;57:469-470 https://doi.org/10.1259/0007-1285-57-678-469
  5. Fabricant JI, Lyman JT, Hosobuchi Y. Stereotactic radiosurgery for intra-cranial vascular formations. Br J Radiol 1984;57:479-490 https://doi.org/10.1259/0007-1285-57-678-479
  6. Heifetz MO, Wexler M, Thompson R. Single-beam radiotherapy knife. A practical theoretical model. J Neurosurg 1984;60:814-818 https://doi.org/10.3171/jns.1984.60.4.0814
  7. Leksell L. Stereotactic radiosurgery. J Neurol Neurosurg Psych 1983;46:797-803 https://doi.org/10.1136/jnnp.46.9.797
  8. Podgorsak EM, Olivier A, Pia M, et al. Dynamic stereotactic radiosurgery. Int J Radiol Oncol Bioi Phys 1988;14: 115-126 https://doi.org/10.1016/0360-3016(88)90059-4
  9. Winston KR, Lutz W. Linear accelerators as neurosurgical tool for stereotactic radiosurgery. Neurosurgery 1988;22:454-463 https://doi.org/10.1227/00006123-198803000-00002
  10. Brenner DJ, Martel MK, Hall EJ. Fractionated regimens for stereotactic radiotherapy of recurrent tumors in the brain. Int J Radiat Oncol Bioi Phys 1991;21:819-824 https://doi.org/10.1016/0360-3016(91)90703-7
  11. Flickinger JC, Kondziolka D, Lunsford LD. Radiosurgery of benign lesions. Semin Radiat Oncol 1995;5:220-224 https://doi.org/10.1016/S1053-4296(05)80020-7
  12. Maire JP, Caudry M, Darouzet V, et al. Fractionated radiation therapy in the treatment of stage III and IV cerebello- pontine angle neurinomas: Long-term results in 24 cases. Int J Radiat Oncol Bioi Phys 1995;32:1137-1143 https://doi.org/10.1016/0360-3016(94)00604-J
  13. Susan F, Nancy J, Hanne M, et al. Stereotactic radiotherapy for pediatric and adult brain tumors: preliminary report. Int J Radiat Oncol Bioi Phys 1994;30:531-539 https://doi.org/10.1016/0360-3016(92)90938-E
  14. Colin P, Scavarda D, et al. Fractionated stereotactic radiotherapy: results in hypophyseal adenomas, acoustic neurinomas, and meningiomas of the cavernous sinus. Cancer Radiother 1998;2:207-214 https://doi.org/10.1016/S1278-3218(98)89092-6
  15. Kim DY, Ahn YC, Huh SJ, et al. Fractionated stereotactic radiation therapy for intracranial benign tumor: preliminary results of clinical application. J Korean Soc Ther Radiol Oncol 1998;16:185-194
  16. Michihide M, Dennis C, et al. Initial clinical results of linac-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas. Int J Radiat Oncol Bioi Phys 1998;42:573-580 https://doi.org/10.1016/S0360-3016(98)00256-9
  17. Kalapurakal JA. Goldman S. Hsieh YC, et al. Clinical outcome in children with recurrent craniopharyngioma after primary surgery. Cancer 2000;6:388-393
  18. Gaderman G, Engenhart R, Schlegel W, et al. Results and comparison of single dose and fractionated radiotherapy in 87 low grade meningiomas. Int J Radiat Oncol Bioi Phys 1993;27(suppl 1):153
  19. Vermeulen S. Young R. Li F, et al. A comparison of single fraction radiosurgery tumor control and toxicity in the treatment of basal and nonbasal meningiomas. Stereotac Func Neurosurg 1999;1:60-66
  20. Debus J. Wuendrich M. Pirzkall A, et al. High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results. JCO 2001;19:3547-3553
  21. Andrews DW, Suarez O, Goldman HW, et al. Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Bioi Phys 2001;50:1265-1278 https://doi.org/10.1016/S0360-3016(01)01559-0
  22. Fuss M, Debus J, Lohr F, et al. Conventionally fractionated stereotactic radiotherapy for acoustic neuromas. Int J Radiat Oncol Bioi Phys 2000;48:1381-1387 https://doi.org/10.1016/S0360-3016(00)01361-4
  23. Rubin P, Casarett GW. Central nervous system. Clinical radiation pathology 1968;2:609-661