Radiation-induced Necrosis Deteriorating Neurological Symptoms and Mimicking Progression of Brain Metastasis after Stereotactic-guided Radiotherapy
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Although radiation-induced necrosis (RIN) is not a tumor in itself, the lesion progressively enlarges with mass effects and diffuse peritumoral edema in a way that resembles neoplasm. To identify the RIN that mimics progression of brain metastasis, we performed surgical resections of symptomatic RIN lesions. Meterials and Methods: From June 2003 to December 2005, 7 patients received stereotactic-guided radiotherapy (SRT) for metastatic brain tumor, and they later underwent craniotomy and tumor resection due to the progressive mass effects and the peritumoral edema that caused focal neurological deficit. On MR imaging, a ring-like enhanced single lesion with massive peritumoral edema could not be distinguished from progression of brain metastasis. Results: Four patients had non-small cell lung cancer, 2 patients had colorectal cancer and 1 patient had renal cell carcinoma. The mean tumor volume was 8.7 ml (range: 3.0～20.7 ml). The prescribed dose of SRT was 30 Gy with 4 fractions for one patient, 18 Gy for two patients and 20 Gy for the other four patients. The four patients who received SRT with a dose of 20 Gy had RIN with or without microscopic residual tumor cells. Conclusions: Early detection of recurrent disease after radiotherapy and identifying radiation-induced tissue damage are important for delivering adequate treatment. Therefore, specific diagnostic tools that can distinguish RIN from progression of metastatic brain tumor need to be developed. (Cancer Res Treat. 2007;39:16-21)
Abstract
Purpose: Although radiation-induced necrosis (RIN) is not a tumor in itself, the lesion progressively enlarges with mass effects and diffuse peritumoral edema in a way that resembles neoplasm. To identify the RIN that mimics progression of brain metastasis, we performed surgical resections of symptomatic RIN lesions. Meterials and Methods: From June 2003 to December 2005, 7 patients received stereotactic-guided radiotherapy (SRT) for metastatic brain tumor, and they later underwent craniotomy and tumor resection due to the progressive mass effects and the peritumoral edema that caused focal neurological deficit. On MR imaging, a ring-like enhanced single lesion with massive peritumoral edema could not be distinguished from progression of brain metastasis. Results: Four patients had non-small cell lung cancer, 2 patients had colorectal cancer and 1 patient had renal cell carcinoma. The mean tumor volume was 8.7 ml (range: 3.0～20.7 ml). The prescribed dose of SRT was 30 Gy with 4 fractions for one patient, 18 Gy for two patients and 20 Gy for the other four patients. The four patients who received SRT with a dose of 20 Gy had RIN with or without microscopic residual tumor cells. Conclusions: Early detection of recurrent disease after radiotherapy and identifying radiation-induced tissue damage are important for delivering adequate treatment. Therefore, specific diagnostic tools that can distinguish RIN from progression of metastatic brain tumor need to be developed. (Cancer Res Treat. 2007;39:16-21)
참고문헌 (24)
- "Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand. 1951", pp.316~9
- Lunsford LD, "Maitz A. Stereotactic radiosurgery of the brain using the first United States 201 cobalt 60 source gamma knife. Neurosurgery. 1989", pp.151~9
- Alexander E 3rd, "Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases", 87, pp.34~40 (1995)
- Davey P, "O’Brien P. Disposition of cerebral metastases from malignant melanoma implications for radiosurgery. Neurosurgery. 1991", pp.8~14
- Lutz W, "Maleki N. A system for stereotactic radiosurgery with a linear accelerator. Int J Radiat Oncol Biol Phys. 1988", pp.373~81
- Kagan AR, "Palliation of brain and spinal cord metastases", pp.2187~2198 (1998), Philadelphia: Lippincott
- Cairncross JG, "Posner JB. Radiation therapy for brain metastases. Ann Neurol. 1981", pp.529~41
- Kooy HM, "et al. Treatment planning for stereotactic radiosurgery of intra-cranial lesions. Int J Radiat Oncol Biol Phys. 1991", pp.683~93
- Mehta MP, "et al. Defining the role of radiosrugery in the management of brain metastases. Int J Radiat Oncol Biol Phys. 1992", pp.619~25
- Phillips MH, "a review and comparison of methods. J Clin Oncol. 1994", pp.1085~99
- Shaw E, "Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases; final report of RTOG protocol 90-05", 47, pp.291~298 (2004)
- Ogawa T, "et al. Clinical value of PET with 18F-fluorodeoxyglucose and L-methyl-11C-methionine for diagnosis of recurrent brain tumor and radiation injury. Acta Radiol. 1991", hiqa(s)
- Kline JL, "Single-photon emission CT in the evaluation of recurrent brain tumor in patients treated with gamma knife radiosurgery or conventional radiation therapy", 17, pp.1681~1686 (1996)
- "Lindquist C. Gamma knife surgery for recurent solitary metastasis of a cerebral hypernephroma", pp.802~4
- Sturm V, "et al. Stereotactic percutaneous single dose irradiation of brain metastases with a linear accelarator. Int J Radiat Oncol Biol Phys. 1987", pp.279~82
- Loeffler JS, "et al. The treatment of recurrent brain metastases with stereotactic radiosurgery. J Clin Oncol. 1990", pp.576~82
- Hu JQ, "Liang ZH. Delayed radiation encephalopathy after radiotherapy for nasopharyngeal cancer a CT study of 45 cases. J Comput Assist Tumogr. 1991"
- Russell DS, "Rubinstein LJ. Effects of radiotherapy and chemotherapy and cranial and spinal tumors and their surrounding tissue. In editor. Pathology of tumors of the nervous system. 5th ed. London" (1989), Butler & Tanner Ltd
- Mesiti M, "et al. Quantitative study of blood-brain barrier permeability changes after experimental whole brain radiation. Neurosurgery. 1992", pp.30~4
- Marcussen WH, "Tiler-Borsich J. The late efects of radiation on the blood-brain barrier. Int J Radiat Oncol Biol Phys. 1986" (1965)
- Cicciarello R, "Time-related ultrastructural changes in an experimental model of whole brain irradiation", 38, pp.772~780 (1996)
- Akio T, "Factors associated with tumor response and survival in radiosurgery for brain metastases", 1, pp.23~30 (1996)
- Schomas DA, "Predictors of tumor control in patients treated with Linac-based stereotactic radiosurgery for metastatic disease to the brain", 28, pp.180~187 (2005)
- Hoffman R, "Radiosugery for brain metastases from primary lung carcinoma", 7, pp.121~131 (2001)