DOI QR코드

DOI QR Code

4개 이상의 다발성 전이성 뇌종양의 정위적 방사선수술과 전뇌 방사선조사의 비교

Comparison of Stereotactic Radiosurgery and Whole Brain Radiotherapy in Patients with Four or More Brain Metastases

  • 김철진 (인제대학교 의과대학 방사선종양학교실) ;
  • 백미영 (인제대학교 의과대학 방사선종양학교실) ;
  • 박성광 (인제대학교 의과대학 방사선종양학교실) ;
  • 안기정 (인제대학교 의과대학 방사선종양학교실) ;
  • 조흥래 (인제대학교 의과대학 방사선종양학교실)
  • Kim, Cheol-Jin (Department of Radiation Oncology, Inje University College of Medicine) ;
  • Baek, Mi-Young (Department of Radiation Oncology, Inje University College of Medicine) ;
  • Park, Sung-Kwang (Department of Radiation Oncology, Inje University College of Medicine) ;
  • Ahn, Ki-Jung (Department of Radiation Oncology, Inje University College of Medicine) ;
  • Cho, Heung-Lae (Department of Radiation Oncology, Inje University College of Medicine)
  • 투고 : 2009.07.23
  • 심사 : 2009.09.14
  • 발행 : 2009.09.30

초록

목 적: 4개 이상의 다발성 전이성 뇌종양에서 정위적 방사선수술의 효용성에 대해서 검증하기 위하여 후향적으로 시행하였다. 대상 및 방법: 2004년 1월부터 2006년 12월까지 본원에서 4개 이상의 다발성 전이성 뇌종양으로 진단되어 정위적 방사선수술을 받은 29명의 환자와 전뇌 방사선조사를 받은 39명의 환자를 대상으로 후향적으로 분석하였다. 소세포 폐암과 흑색종으로 진단받은 환자는 제외하였고, 원발 병소는 정위적 방사선수술군에서는 폐암이 69.0%, 유방암이 13.8%였고, 전뇌 방사선조사군에서는 폐암이 64.1%, 유방암이 15.4%, 대장-직장암이 12.8%였다. 정위적 방사선수술은 감마나이프를 이용하여 시술하였고, 50% 등선량 곡선에 10~20 Gy를 1회 조사하였다. 전뇌 방사선조사는 30 Gy, 10회 분할조사 하였다. 치료 후 뇌 자기공명영상 또는 조영 증강 컴퓨터 단층촬영을 시행하여 두 군에서 치료 후 전이성 뇌종양이 진행되기까지 걸린 기간과 전체 생존율에 대해 비교 분석하였다. 결 과: 두 군의 추척 관찰 기간은 2개월에서 23개월이었고, 정위적 방사선수술군의 추적관찰 기간 중앙값은 5개월, 전뇌 방사선조사군의 경우에는 6개월이었다. 뇌전이 숫자의 중앙값이 정위적 방사선수술군에서는 6개, 전뇌 방사선조사군에서는 5개였다. 전이성 뇌종양의 진행을 억제하는 효과를 보여주는 두개내 무진행 생존율은 정위적 방사선수술군에서는 5.1개월, 전뇌 방사선조사군에서는 6.1개월이었고, 정위적 방사선수술을 시행한 환자들의 전체 생존율의 중앙값은 5.6개월, 전뇌 방사선조사를 시행한 환자들은 7.2개월이었다. 결 론: 4개 이상의 다발성 뇌 전이에 있어서 정위적 방사선수술은 전뇌 방사선조사에 비해 그 효용성이 낮으며 전뇌 방사선조사를 시행하는 것이 바람직할 것으로 판단된다.

Purpose: This study was a retrospective evaluation of the efficacy of stereotactic radiosurgery (SRS) in patients with >4 metastases to the brain. Materials and Methods: Between January 2004 and December 2006, 68 patients with $\geq$4 multiple brain metastases were included and reviewed retrospectively. Twenty-nine patients received SRS and 39 patients received whole brain radiotherapy (WBRT). Patients with small cell lung cancers and melanomas were excluded. The primary lesions were non-small cell lung cancer (69.0%) and breast cancer (13.8%) in the SRS group and non-small cell lung cancer (64.1%), breast cancer (15.4%), colorectal cancer (12.8%), esophageal cancer (5.1%) in the WBRT group. SRS involved gamma-knife radiosurgery and delivered 10~20 Gy (median, 16 Gy) in a single fraction with a 50% marginal dose. WBRT was delivered daily in 3 Gy fractions, for a total of 30 Gy. After completion of treatment, a follow-up brain MRI or a contrast-enhanced brain CT was reviewed. The overall survival and intracranial progression-free survival were compared in each group. Results: The median follow-up period was 5 months (range, 2~19 months) in the SRS group and 6 months (range, 4~23 months) in the WBRT group. The mean number of metastatic lesions in the SRS and WBRT groups was 6 and 5, respectively. The intracranial progression-free survival and overall survival in the SRS group was 5.1 and 5.6 months, respectively, in comparison to 6.1 and 7.2 months, respectively, in the WBRT group. Conclusion: SRS was less effective than WBRT in the treatment of patients with >4 metastases to the brain.

키워드

참고문헌

  1. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990;322:494-500 https://doi.org/10.1056/NEJM199002223220802
  2. Patchell RA, Tibbs PA, Regine WF, et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 1998;280:1485-1489 https://doi.org/10.1001/jama.280.17.1485
  3. Cairncross JG, Kim JH, Posner JB. Radiation therapy for brain metastases. Ann Neurol 1980;7:529-541 https://doi.org/10.1002/ana.410070606
  4. Andre F, Slimane K, Bachelot T, et al. Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol 2004;22:3302-3308 https://doi.org/10.1200/JCO.2004.08.095
  5. Zabel A, Milker-Zabel S, Thilmann C, et al. Treatment of brain metastases in patients with non-small cell lung cancer (NSCLC) by stereotactic linac-based radiosurgery: prognostic factors. Lung Cancer 2002;37:87-94
  6. Walker AE, Robins M, Weinfield FD. Epidemiology of brain tumors: the national survey of intracranial neoplasms. Neurology 1985;35:219-226 https://doi.org/10.1212/WNL.35.2.219
  7. Borgelt B, Gelber R, Kramer S, et al. The palliation of brain metastases: the final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1980;6:1-9 https://doi.org/10.1016/0360-3016(80)90195-9
  8. Deutsch M, Parsons JA, Mercado R. Radiotherapy for intracranial metastases. Cancer 1974;34:1607-1611 https://doi.org/10.1002/1097-0142(197411)34:5<1607::AID-CNCR2820340508>3.0.CO;2-N
  9. Noordijk EM, Vecht CJ, Haaxma-Reiche H, et al. The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 1994;29:711-717 https://doi.org/10.1016/0360-3016(94)90558-4
  10. Alexander E, Moriarty TM, Davis RB, et al. Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst 1995;87:34-40 https://doi.org/10.1093/jnci/87.1.34
  11. Varlotto JM, Flickinger JC, Niranjan A, Bhatnagar A, Kondziolka D, Lunsford LD. The impact of whole-brain radiation therapy on the long-term control and morbidity of patients surviving more than one year after gamma knife radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 2005;62:1125-1132 https://doi.org/10.1016/j.ijrobp.2004.12.092
  12. Weltman E, Salvajoli JV, Brandt RA, et al. Radiosurgery for brain metastases: who may not benefit? Int J Radiat Oncol Biol Phys 2001;51:1320-1327 https://doi.org/10.1016/S0360-3016(01)01696-0
  13. Sneed PK, Lamborn KR, Forstner JM, et al. Radiosurgery for brain metastases: is whole brain radiotherapy necessary? Int J Radiat Oncol Biol Phys 1999;43:549-558 https://doi.org/10.1016/S0360-3016(98)00447-7
  14. Jagannathan J, Sherman JH, Mehta GU, Chin LS. Radiobiology of brain metastasis: applications in stereotactic radiosurgery. Neurosurg Focus 2007;22:e4
  15. Schoeggl A, Kitz K, Ertl A, et al. Prognostic factor analysis for multiple brain metastases after gamma knife radiosurgery: results in 97 patients. J Neurooncol 1999;42:169-175 https://doi.org/10.1023/A:1006110631704
  16. Gaspar L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997;37:745-751 https://doi.org/10.1016/S0360-3016(96)00619-0
  17. Joseph J, Adler JR, Cox RS, Hancock SL. Linear accelerator-based stereotaxic radiosurgery for brain metastases:the influence of number of lesions on survival. J Clin Oncol 1996;14:1085-1092
  18. Chougule PB, Burton-Williams M, Saris S, et al. Randomized treatment of brain metastasis with gamma knife radiosurgery, whole brain radiotherapy or both. Int J Radiat Oncol Biol Phys 2000;48(Suppl. 1):114
  19. Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys 1999;45:427-434
  20. Andrews DW, Scott CB, Sperduto PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004;363:1665-1672 https://doi.org/10.1016/S0140-6736(04)16250-8
  21. Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases. A randomized controlled trial. JAMA 2006;295:2483-2491 https://doi.org/10.1001/jama.295.21.2483
  22. Hasegawa T, Kondziolka D, Flickinger JC, et al. Brain metastases treated with radiosurgery alone: an alternative to whole brain radiotherapy? Brarosurgery 2003;52:1318-1326
  23. Flickinger JC, Kondziolka D, Lunsford LD, et al. A multiinstitutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 1994;28:797-802 https://doi.org/10.1016/0360-3016(94)90098-1
  24. Kihlstrom L, Karlsson B, Lindquist C. Gamma knife surgery for cerebral metastases. Implications for survival based on 16 years experience. Stereotact Funct Neurosurg 1993;61:45-50 https://doi.org/10.1159/000100659
  25. Yoo H, Kim YZ, Nam BH, et al. Reduced local recurrence of a single brain metastasis through microscopic total resection. J Neurosurg 2009;110:730-736 https://doi.org/10.3171/2008.8.JNS08448
  26. Mehta MP, Tsao MN, Whelan TJ, et al. The american society for therapeutic radiology and oncology (ASTRO)evidence-based review of the role of radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 2005;63:37-46 https://doi.org/10.1016/j.ijrobp.2005.05.023
  27. Bhatnagar AK, Flickinger JC, Kondziolka D, Lunsford LD. Stereotactic radiosurgery for four or more intracranial metastases. Int J Radiat Oncol Biol Phys 2006;64:898-903 https://doi.org/10.1016/j.ijrobp.2005.08.035
  28. Coffey RJ, Flickinger JC, Bissonette DJ, et al. Radiosurgery for solitary brain metastases using the cobalt-60 gamma unit: methods and results in 24 patients. Int J Radiat Oncol Biol Phys 1991;20:1287-1295 https://doi.org/10.1016/0360-3016(91)90240-5
  29. Mehta MP, Rozental JM, Levin AB, et al. Defining the role of radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 1992;24:619-625 https://doi.org/10.1016/0360-3016(92)90706-N
  30. Engenhart R, Kimmig BN, Hover KH, et al. Long-term follow-up for brain metastases treated by percutaneous stereotatic single high-dose irradiation. Cancer 1993;71:1353-1361 https://doi.org/10.1002/1097-0142(19930215)71:4<1353::AID-CNCR2820710430>3.0.CO;2-6
  31. Cho KH, Hall WA, Gerbi BJ, Higgins PD. The role of radiosurgery for multiple brain metastases. Neurosurg Focus 2000;9:e2
  32. Chang SD, Adler JR Jr. Current treatment of patients with multiple brain metastases. Neurosurg Focus 2000;9:e5
  33. Chang SD, Lee E, Sakamoto GT, Brown NP, Adler JR. Stereotactic radiosurgery in patients with multiple brain metastases. Neurosurg Focus 2000;9:e3

피인용 문헌

  1. Survival Outcomes after Whole Brain Radiation Therapy and/or Stereotactic Radiosurgery for Cancer Patients with Metastatic Brain Tumors in Korea: A Systematic Review vol.14, pp.12, 2013, https://doi.org/10.7314/apjcp.2013.14.12.7401