Progress in Medical Physics (한국의학물리학회지:의학물리)

Korean Society of Medical Physics (한국의학물리학회)
권호 표지
DOI QR코드

DOI QR Code

Outcomes after Reirradiation for Brain Metastases

방사선 재치료를 시행한 뇌전이환자의 결과 분석

  • Yu, Jesang (Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Choi, Ji Hoon (Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Ma, Sun Young (Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Jeung, Taesig (Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine)
  • 유제상 (고신대학교 복음병원 방사선종양학과, 고신대학교 의과대학 방사선종양학교실) ;
  • 최지훈 (고신대학교 복음병원 방사선종양학과, 고신대학교 의과대학 방사선종양학교실) ;
  • 마선영 (고신대학교 복음병원 방사선종양학과, 고신대학교 의과대학 방사선종양학교실) ;
  • 정태식 (고신대학교 복음병원 방사선종양학과, 고신대학교 의과대학 방사선종양학교실)
  • Received : 2015.09.01
  • Accepted : 2015.09.14
  • Published : 2015.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

We retrospectively analyzed the outcomes in patients who underwent reirradiation for brain metastasis. Twenty-three patients with brain metastases who were initially treated with palliative brain radiotherapy and were retreated with a second course of brain RT between June 2008 and December 2012. WBRT, 3DCRT and SRS were used for brain metastasis. The median dose of the first course of WBRT was 30 Gy (range, 23.4~30 Gy). The dose of the first course 3DCRT for lesion was 30 Gy in 3 Gy per fraction. The median dose of the first course of SRS was 16 Gy in 1 fraction (range, 12~24 Gy). The median dose of the second course of WBRT was 27.5 (range, 12~30 Gy). The median dose of the second course of 3DCRT for lesion was 30 Gy (range, 25~30 Gy). The dose of the second course of SRS was 16 Gy in 1 fraction. The second course of WBRT was administered on radiographic disease progression with symptom in all patients. With median follow-up of 25 months, overall symptom resolution rates were 47.8%. Rate of palliative efficacy was 82.6% including stable disease. The median survival time after initiation of reirradiation was 3.2 months. Median value of KPS prior to reirradiation was 30. Median value of KPS after reirradiation was 60. Reirradiation of brain metastasis maybe feasible and effective in select patients with a good performance status $KPS{\geq}60$ (: ECOG 0~2) prior to reirradiation.

방사선 재치료를 받은 뇌전이 환자를 대상으로 치료결과와 결과에 영향을 미치는 인자를 알아보고자 하였다. 2008년 6월부터 2012년 12월까지 완화목적의 뇌 방사선치료를 받은후 방사선 재치료를 받은 23명의 환자의 결과를 분석하였다. 첫 번째 전뇌 방사선치료 선량의 중앙값은 30 Gy (23.4~30 Gy) 이었다. 삼차원입체치료의 선량은 하루에 3 Gy로 총 30 Gy를 분할조사하였다. 정위적 방사선수술의 선량은 16 Gy를 1회 조사하였다. 방사선 재치료에서 전뇌 방사선치료, 삼차원 입체조형 치료의 중앙값은 각각 27.5 Gy와 30 Gy 이었다. 정위적 방사선수술의 재치료 선량은 16 Gy를 1회 조사하였다. 완화목적의 뇌 방사선치료 이후 뇌전이로 인한 증상 악화를 동반하고 영상학적으로 병변 진행이 확인되는 환자에서 방사선 재치료를 시행하였다. 경과 관찰기간의 중앙값은 25개월 이었다. 증상 관해율은 47.8%였고, 증상 완화의 효과 비율은 증상 유지 환자를 포함하여 82.6% 이었다. 재치료후 생존기간의 중앙값은 3.2개월이었다. 방사선 재치료 이후의 중앙값은 60으로 재치료 이전의 KPS 중앙값 30에 비해 향상되었다. 뇌전이 환자에서 방사선 재치료의 증상 완화 효과는 치료이전 KPS값이 60이상(: ECOG 0~2)의 전신수행상태가 좋은 환자에서 적합한 것으로 결과를 나타내었다.

Keywords

References

  1. Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain Metastases Histology, Multiplicity, Surgery, and Survival. Cancer 1996;78:1781-8. https://doi.org/10.1002/(SICI)1097-0142(19961015)78:8<1781::AID-CNCR19>3.0.CO;2-U
  2. Barani IJ, Larson DA, Berger MS. Future directions in treatment of brain metastases. Surg Neurol Int 2013;4:220-31. https://doi.org/10.4103/2152-7806.111299
  3. Gravrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neuro Oncol 2005;75:5-14. https://doi.org/10.1007/s11060-004-8093-6
  4. Neider C, Spanne O, Mehta MP, Grosu AL, Geinitz H. Presentation, patterns of care, and survival in patients with brain metastases. Cancer 2011;117:2505-12. https://doi.org/10.1002/cncr.25707
  5. Wong J, Hird A, Zhang L, et al. Symptoms and quality of life in cancer patients with brain metastases following palliative radiotherapy. Int J Radiat Oncol Biol Phys 2009;75:1125-31. https://doi.org/10.1016/j.ijrobp.2008.12.013
  6. Minniti G, Scaringi C, Lanzetta G, et al. Whole brain reirradiation and concurrent temozolomide in patients with brain metastases. J Neurooncol 2014;118:329-34. https://doi.org/10.1007/s11060-014-1435-0
  7. Ozgen Z, Atasoy BM, Kefeli AU, et al. The benefit of whole brain reirradiation in patients with multiple brain metastases. Radiat Oncol 2013;8:186. https://doi.org/10.1186/1748-717X-8-186
  8. Wong WW, Schild SE, Sawyer TE, Shaw EG. Analysis of outcome in patients reirradiated for brain metastases. Int J Radiat Oncol Biol Phys 1996;34:585-90. https://doi.org/10.1016/0360-3016(95)02156-6
  9. Lucas JT, Colmer HG, White L, et al. Competing risk analysis of neurologic versus nonneurologic death in patients undergoing radiosurgical salvage after whole-brain radiation therapy failure: who actually dies of their brain metastases. Int J Radiat Oncol Biol Phys 2015;92:1008-15. https://doi.org/10.1016/j.ijrobp.2015.04.032
  10. Yuan H, Gaber MW, Boyd K, et al. Effect of fractionated radiation on the brain vasculature in a murine model: bloodbrain barrier permeability, astrocyte proliferation, and ultrastructural changes. Int J Radiat Oncol Biol Phys 2006;66:860-6. https://doi.org/10.1016/j.ijrobp.2006.06.043
  11. Mayer R. Sminia P. Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys 2008;70:1350-60. https://doi.org/10.1016/j.ijrobp.2007.08.015
  12. Son CH, Jimenez R, Niemierko A, et al. Outcome after whole brain reirradiation in patients with brain metastases. Int J Radiat Oncol Biol Phys 2012;82:e167-72. https://doi.org/10.1016/j.ijrobp.2011.03.020
  13. Adkison JB, Tome W, Seo S, et al. Reirradiation of largevolume recurrent glioma with pulsed reduced-dose-rate radiotherapy. Int J Radiat Oncol Biol Phys 2011;79:835-41. https://doi.org/10.1016/j.ijrobp.2009.11.058
  14. Maranzano E, Trippa F, Casale M, et al. Reirradiation of brain metastases with radiosurgery. Radiother Oncol 2012;102: 192-7. https://doi.org/10.1016/j.radonc.2011.07.018
  15. Olson AC, Wegner RE, Rwigema JCM, et al. Clinical outcomes of reirradiation of brain metastases from small cell lung cancer with Cyberknife stereotactic radiosurgery. J Cancer Res and Ther 2012;8:411-6. https://doi.org/10.4103/0973-1482.103522
  16. Paulino AC, Mai WY, Chintagumpala M, Taher A, The BS. Radiation-induced malignant gliomas: is there a role for reirradiation? Int J Radiat Oncol Biol Phys 2008;71:1381-7. https://doi.org/10.1016/j.ijrobp.2007.12.018
  17. Shaw E, Scott C, Souhami L, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: Final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 2000;47:291-8. https://doi.org/10.1016/S0360-3016(99)00507-6
  18. Veninga T, Langendijk HA, Slotman BJ, et al. Reirradiation of primary brain tumours: survival, clinical response and prognostic factors. Radiother Oncol 2011;59:127-37.
  19. E, Bezjak A, Yi QL, et al. Value of whole brain re-irradiation for brain metastases - single centre experience. Clin Oncol 2007;19:532-8. https://doi.org/10.1016/j.clon.2007.06.001
  20. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991;21:109-22.
  21. Lawrence YR, Li XA, el Naqa I, et al. Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys 2010; 76(3Suppl):S20-7. https://doi.org/10.1016/j.ijrobp.2009.02.091

Cited by

  1. Evaluations of the setup discrepancy between BrainLAB 6D ExacTrac and cone-beam computed tomography used with the imaging guidance system Novalis-Tx for intracranial stereotactic radiosurgery vol.12, pp.5, 2017, https://doi.org/10.1371/journal.pone.0177798