Zračenje celog mozga uz istovremeni integrisani dodatak doze kod oligometastatske bolesti mozga
Sažetak
Apstrakt
Uvod/Cilj. Metastaze u mozgu se javljaju kod 20%–30% bolesnika sa sistemskom malignom bolešću. Cilj istraživanja bio je da se utvrdi da li bolesnici sa oligometastatskom bolešću mozga, tretirani zračenjem celog mozga (WBRT) u kombinaciji sa istovremenim ozračivanjem moždanih metastaza (SIBmets), imaju poboljšano ukupno preživljavanje (klinički ishod) u poređenju sa bolesnicima iz Radiation Therapy Oncology Group (RTOG) 9508 baze podataka, tretiranim sa WBRT i sekvencijalnom stereotaktičnom radiohirurgijom (SRS) moždanih metastaza. Metode. Zračenje WBRT sa SIBmets sprovedeno je volumetrijski modulisanom lučnom zračnom tehnikom (VMAT), pri čemu je zračenje celog mozga sprovedeno dozom 20 Gy u pet frakcija uz simultano zračenje metastaza mozga sa dodatnih 20 Gy u pet frakcija. Analizirano je 15 bolesnika sa prethodno verifikovanim metastazama u mozgu (od 1 do 3 metastaze) pomoću kompjuterizovane tomografije/magnetne rezonancije (CT/MRI), prečnika manjeg od 40 mm za najveće lezije. Rezultati. Petnaest bolesnika je bilo obuhvaćeno istraživanjem, osam muškaraca i sedam žena, prosečne dobi od 56,3 godine. Prema kriterijumima RTOG Recursive Partitioning Analysis (RPA), tri bolesnika su bila u klasi I, a 12 bolesnika u klasi II. Četiri bolesnika imala su jednu metastazu, a 11 bolesnika dve metastaze u mozgu. Izračunato srednje vreme preživljavanja (MST) bilo je 7.49 ± 4,36 meseci, bez statistički značajne razlike u poređenju sa rezultatima RTOG 4508 (MST = 6,5 meseci) (p = 0.1975). Stopa lokalne kontrole metastatske bolesti za sedam bolesnika nakon tri meseca bila je 85.7%. Zaključak. WBRT sa SIBmets je klinički ekvivalentan tretmanu WBRT + SRS za pacijente sa oligometastatskom bolešću mozga. U poređenju sa WBRT + SRS, primena WBRT + SIBmets tehnike zračenja skraćuje vreme lečenja i poboljšava komfor bolesnika.
Reference
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