CyberKnife? enhanced conventionally fractionated chemoradiation for high grade glioma in close proximity to critical structures
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- 作者：Eric Oermann (1)
Brian T Collins (1)
Kelly T Erickson (1)
Xia Yu (1)
Sue Lei (1)
Simeng Suy (1)
Heather N Hanscom (1)
Joy Kim (1)
Hyeon U Park (1)
Andrew Eldabh (1)
Christopher Kalhorn (2)
Kevin McGrail (2)
Deepa Subramaniam (3)
Walter C Jean (1) (2)
Sean P Collins (1) - 刊名：Journal of Hematology & Oncology
- 出版年：2010
- 出版时间：December 2010
- 年：2010
- 卷：3
- 期：1
- 全文大小：1010KB
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Brian T Collins (1)
Kelly T Erickson (1)
Xia Yu (1)
Sue Lei (1)
Simeng Suy (1)
Heather N Hanscom (1)
Joy Kim (1)
Hyeon U Park (1)
Andrew Eldabh (1)
Christopher Kalhorn (2)
Kevin McGrail (2)
Deepa Subramaniam (3)
Walter C Jean (1) (2)
Sean P Collins (1)
1. Department of Radiation Oncology, Georgetown University Hospital, Washington, DC, USA
2. Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA
3. Department of Hematology and Oncology, Georgetown University Hospital, Washington, DC, USA - ISSN：1756-8722
文摘
Introduction With conventional radiation technique alone, it is difficult to deliver radical treatment (?60 Gy) to gliomas that are close to critical structures without incurring the risk of late radiation induced complications. Temozolomide-related improvements in high-grade glioma survival have placed a higher premium on optimal radiation therapy delivery. We investigated the safety and efficacy of utilizing highly conformal and precise CyberKnife radiotherapy to enhance conventional radiotherapy in the treatment of high grade glioma. Methods Between January 2002 and January 2009, 24 patients with good performance status and high-grade gliomas in close proximity to critical structures (i.e. eyes, optic nerves, optic chiasm and brainstem) were treated with the CyberKnife. All patients received conventional radiation therapy following tumor resection, with a median dose of 50 Gy (range: 40 - 50.4 Gy). Subsequently, an additional dose of 10 Gy was delivered in 5 successive 2 Gy daily fractions utilizing the CyberKnife? image-guided radiosurgical system. The majority of patients (88%) received concurrent and/or adjuvant Temozolmide. Results During CyberKnife treatments, the mean number of radiation beams utilized was 173 and the mean number of verification images was 58. Among the 24 patients, the mean clinical treatment volume was 174 cc, the mean prescription isodose line was 73% and the mean percent target coverage was 94%. At a median follow-up of 23 months for the glioblastoma multiforme cohort, the median survival was 18 months and the two-year survival rate was 37%. At a median follow-up of 63 months for the anaplastic glioma cohort, the median survival has not been reached and the 4-year survival rate was 71%. There have been no severe late complications referable to this radiation regimen in these patients. Conclusion We utilized fractionated CyberKnife radiotherapy as an adjunct to conventional radiation to improve the targeting accuracy of high-grade glioma radiation treatment. This technique was safe, effective and allowed for optimal dose-delivery in our patients. The value of image-guided radiation therapy for the treatment of high-grade gliomas deserves further study.