METHODS: Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnifeⓇ (CK), Gamma KnifeⓇ (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED10Gy (BED10Gy95% and BED10Gy90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V83Gy, V103Gy, V123Gy and V243Gy) to the normal brain were evaluated by a Wilcoxon-signed rank test.
RESULTS: For RC + 0 mm, median BED10Gy 90% for STaRT (90.1 Gy10, range: 64.1-140.9 Gy10) was significantly higher than CK (74.3 Gy10, range:59.3-80.4 Gy10, p = 0.04), GK (69.4 Gy10, range: 59.8-77.1 Gy10, p = 0.005), and IMPT (49.3 Gy10, range: 49.0-49.7 Gy10, p = 0.003), respectively. However, for the RC + 5 mm, the median BED10Gy 90% for STaRT (34.1 Gy10, range: 22.2-59.7 Gy10) was significantly lower than CK (44.3 Gy10, range: 37.8-52.4 Gy10), and IMPT (46.6 Gy10, range: 45.1-48.5 Gy10), respectively, but not significantly different from GK (34.1 Gy10, range: 22.8-47.0 Gy10). The median V243Gy was significantly higher in CK (11.7 cc, range: 4.7-20.1 cc), GK(6.2 cc, range: 2.3-11.9 cc) and IMPT (19.9 cc, range: 11.1-36.6 cc) compared to STaRT (1.1 cc, range: 0.0-7.8 cc) (p < 0.01).
CONCLUSIONS: This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches.
方法:用CyberKnife®(CK)重新扫描9例(n=9)有12个切除腔(RC)的患者接受STaRT(累积物理剂量为60Gy至距离RC边缘5mm的深度)。伽马射线(GK),和使用SRT方法(5个部分中的30Gy)的强度调节质子治疗(IMPT)。比较BED10Gy中的D95%和D90%(BED10Gy95%和BED10Gy90%)和RC+0至+5mm扩展边缘的统计学显著性,和与放射性坏死风险相关的参数(V83Gy,V103Gy,通过Wilcoxon符号秩检验评估正常大脑的V123Gy和V243Gy)。
结果:对于RC+0mm,STaRT的BED10Gy中位数90%(90.1Gy10,范围:64.1-140.9Gy10)显着高于CK(74.3Gy10,范围:59.3-80.4Gy10,p=0.04),GK(69.4Gy10,范围:59.8-77.1Gy10,p=0.005),和IMPT(49.3Gy10,范围:49.0-49.7Gy10,p=0.003),分别。然而,对于RC+5毫米,STaRT的中位数BED10Gy90%(34.1Gy10,范围:22.2-59.7Gy10)显着低于CK(44.3Gy10,范围:37.8-52.4Gy10),和IMPT(46.6Gy10,范围:45.1-48.5Gy10),分别,但与GK(34.1Gy10,范围:22.8-47.0Gy10)没有显着差异。CK的V243Gy中位数明显更高(11.7cc,范围:4.7-20.1cc),GK(6.2cc,范围:2.3-11.9cc)和IMPT(19.9cc,范围:11.1-36.6cc)与STaRT(1.1cc,范围:0.0-7.8cc)(p<0.01)。
结论:该比较分析表明,与EBRT方法相比,STaRT方法可以通过在距RC边缘至少3mm处的等效或更大BED递送更高的辐射剂量来有效治疗复发性脑肿瘤。