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Neurological Surgery No Shinkei Geka Volume 24, Issue 11 （November 1996）

Neurological Surgery 脳神経外科 24巻11号（1996年11月発行）

Japanese English

研究

転移性脳腫瘍に対する直線加速器による定位的放射線照射 Stereotactic irradiation for brain metastases using linear accelerator 加藤功 ¹ , 白土博樹 ² , 鈴木恵士郎 ³ , 高邑明夫 ⁴ , 富田雅義 ⁵ , 西岡健 ² , 井須豊彦 ⁶ , 宮町敬吉 ⁷ , 澤村豊 ¹ , 宮坂和男 ² , 阿部弘 ¹ Tsutomu KATO ¹ , Hiroki SHIRATO ² , Keishiro SUZUKI ³ , Akio TAKAMURA ⁴ , Masayoshi TOMITA ⁵ , Takashi NISHIOKA ² , Toyohiko ISU ⁶ , Keikichi MIYAMACHI ⁷ , Yutaka SAWAMURA ¹ , Kazuo MIYASAKA ² , Hiroshi ABE ¹ ¹北海道大学脳神経外科 ²北海道大学放射線科 ³帯広厚生病院放射線科 ⁴旭川厚生病院放射線科 ⁵日鋼記念病院放射線科 ⁶釧路労災病院脳神経外科 ⁷日鋼記念病院脳神経外科 ¹Department of Neurosurgery, Hokkaido University School of Medicine ²Department of Radiology, Hokkaido University School of Medicine ³Department of Radiology, Obihiro Kohsei Hospital ⁴Department of Radiology, Asahikawa Kohsei Hospital ⁵Department of Therapeutic and Diagnostic Radiology, Nikkoh Memorial Hospital ⁶Department of Neurosurgery, Kushiro Rohsai Hospital ⁷Department of Neurosurgery, Nikkoh Memorial Hospital キーワード： stereotactic radiotherapy , radiosurgery , brain metastasis , linear accelerator Keyword: stereotactic radiotherapy , radiosurgery , brain metastasis , linear accelerator pp.1003-1009

発行日 1996年11月10日 Published Date 1996/11/10

DOI https://doi.org/10.11477/mf.1436901299

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Abstract 文献概要
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I．はじめに

　近年，脳内小病変に対する新しい治療方法として，定位的放射線照射（stereotactic irradiation，STI）が注目されている．この方法には定位的一回照射法のいわゆるradiosurgery（SRS）と，定位的分割照射法（fractionated stereotactic radiotherapy，FSR）があり，ガンマナイフによるSRSの治療効果は確立されている．今回，転移性脳腫瘍に対して，リニアックX線を用いたSRSあるいはFSRによる治療効果をまとめ，その有効性について報告する．

A stereotactic irradiation (STI) system using a linear accelerator was developed and its effectiveness for brain metastasis was investigated. The system consisted of a conventional linear accelerator, invasive fixation head frame (RADFRAME, Mizuho Ika Kogyo), and a tungsten collimator. The RADFRAME was developed to be used with any linear accelerators and with any dose planning systems. The accuracy of the irradiation was assured to be within±1.5mm. Fifty-one patients with metastatic brain tumors were treated using the system. The overall median survival time was 10 months. No difference in survival was observed be-tween patients with a single lesion and patients with two or three lesions. Complete, partial, and minimal re-sponses were obtained in 16 (39%), 18 (41%), and 7 (16%) lesions. These were comparable to the reported results of gamma knife treatment. A maximum dose of 25 Gy was suggested to be more effective than lower doses. Local Control rate was higher in tumors with a diameter of less than 2.0cm (87.5%) than in larger tumors (60%). No difference in tumor response was observed among various histopathologic types. In a pa-tient with a 25mm cerebellar metastasis from an adeno-carcinoma of the lung, autopsy at 5 months after STI showed fibrinoid degeneration and hyaline deposition without residual tumor at the Gd-enhanced region on MRI. The efficacy of linac stereotactic irradiation was equal to that of gamma knife radiotherapy for metasta-tic brain tumors.