PDF(Pubmed)
Abstract：
Brain metastases during pregnancy poses complex conundrum in management. Stereotactic radiosurgery (SRS) offers valuable option to clinicians in this scenario. We reviewed and described the safety and effectiveness of Gamma Knife (GK) SRS in treating a solitary cerebellar metastasis in a patient with recurrent breast cancer at 28 weeks of gestation. Following multidisciplinary discussion, she consented for urgent single session GK SRS to the brain metastasis with 2 cycles of 3-weekly paclitaxel chemotherapy prior to planned delivery at term. Prior to the frame-based treatment, a trial run with dosimeters placed on the superior and inferior parts of foam knee support showed radiation exposure of 3.12 mSv and 1.06 mSv respectively. A prescription dose of 16 Gy at the 50% isodose was delivered using 24 isocentres over 39.7\' of beam on time. The treatment plan had 98% coverage, 89% selectivity and a gradient index of 2.98. Dosimeters placed near the uterine fundus and suprapubic region (consistent with location of fetal head) during the actual treatment recorded 2.83 mSv and 0.27 mSv, which is lower than the trial dosimeter readings. The patient successfully completed SRS treatment and gave birth to a healthy baby two months later. Follow-up MRI at three months interval showed total resolution of the lesion. GK SRS is known for the lowest extracranial dose compared to other SRS modalities. This report and literature review confirmed that GK is a sharp and effective, yet gentle and safe treatment for pregnant patients with brain metastases.
摘要：
怀孕期间的脑转移在管理中提出了复杂的难题。在这种情况下，立体定向放射外科（SRS）为临床医生提供了宝贵的选择。我们回顾并描述了伽玛刀（GK）SRS治疗妊娠28周时复发性乳腺癌患者孤立性小脑转移的安全性和有效性。经过多学科讨论，她同意在计划的足月分娩前对脑转移患者进行紧急单期GKSRS,并进行2个周期的3周紫杉醇化疗.在基于框架的治疗之前，在泡沫膝盖支撑的上部和下部放置剂量计的试验显示，辐射暴露分别为3.12mSv和1.06mSv。在39.7束时间内，使用24个等中心递送了50％等剂量的16Gy的处方剂量。治疗计划有98%的覆盖率，89%的选择性和2.98的梯度指数。在实际治疗期间，放置在子宫底和耻骨上区域（与胎儿头部位置一致）附近的剂量计记录为2.83mSv和0.27mSv，低于试验剂量计读数。患者成功完成SRS治疗，两个月后生下健康宝宝。间隔三个月的随访MRI显示病变的总分辨率。与其他SRS模式相比，GKSRS的颅外剂量最低。本报告和文献综述证实，GK是一种锋利而有效的，然而温和和安全的治疗妊娠脑转移患者。
