Meningiomalarda stereotaktik radyoterapi: Cyberknife-M6 deneyimi: retrospektif çalışma
Abstract
Bu çalışmada birimimizde CyberKnife-M6 (CK-M6) cihazı ile stereotaktik radyoterapi (SRT) uygulanan meningiomalı hastaların etkinlik ve dozimetrik açıdan değerlendirilmesi amaçlandı. Ocak 2019-Şubat 2022 arasında 31 lezyon/26 olgu tedavi edildi ve Haziran 2022’de ortanca 12 ay (1-40) izlem ile değerlendirildi. Ortanca yaş 56 (21-84), ortanca KPS 90 (40-100) ve erkek/kadın oranı 9/17 idi. Tanıda 4 olguda multipl, 22 olguda soliter lezyon vardı. En az bir kez cerrahi uygulanan 17 olgunun %65’i grad I, %35’i grad II meningiom tanısı almıştı. Ortanca Ki-67 %2.5 (% 0,8-35) idi. Beş olguda RT öyküsü vardı. Tanıdan SRT’ye kadar geçen süre 28 ay (1-244) idi. SRT öncesi ortanca çap 22 mm (6-50) olup planlama hedef volüm 8,24 cc (0,47- 63,99) idi. Ortanca 25 Gy/5 fraksiyon (13-27 Gy/1-5 fx), ortanca 18 dk (13-25) tedavi süresi ile uygulandı. Hiçbir olguda geç yan etki ve yeni nörolojik defisit gözlenmedi. Ortanca 3 ayda (1-8), parsiyel yanıt %16, stabil yanıt %76 bulundu. Son değerlendirmede %88 olguda lokal kontrol sağlanmıştı. Ortalama ve 2 yıl genel sağkalım (GSK) 38,5 ay ve %96,2 bulundu. Tek değişkenli analizde, GSK açısından KPS ≥ 80 olması (1 yıl %100 vs %80, p=0,04) ve soliter lezyon varlığı (1 yıl %100 vs %66,7, p=0,006) anlamlı bulundu. CK-M6 hasta uyumunu artırmakta, aynı zamanda tedavi süresi ve vücut dozunu azaltarak ikincil kanser riskini azaltmaktadır. Olgularımızda %88 lokal kontrol elde edilmiş olup CK-M6 bazlı SRT etkin, güvenli ve konforlu bulunmuştur.
This study aimed to evaluate the effectiveness and dosimetric features of meningioma patients who received stereotactic radiotherapy (SRT) with the CyberKnife-M6 (CK-M6) device in our department. Between January 2019 and February 2022, 31 lesions/26 cases were treated and evaluated in June 2022 with a median follow-up of 12 months (1-40). Median age was 56 (21-84), median KPS was 90 (40-100), and male/female ratio was 9/17. At diagnosis, there were multipl lesions in 4 patients and solitary lesions in 22 patients. Of the 17 patients who underwent surgery at least once, 65% were diagnosed with grade I meningioma and 35% with grade II meningioma. The median Ki-67 was 2.5% (0.8-35 %). There was a history of RT in five cases. The time from diagnosis to SRT was 28 months (1-244). The median lesion size before SRT was 22 mm (6-50) and the planning target volume was 8.24 cc (0.47-63.99). A median of 25 Gy/5 fractions (13-27 Gy/1-5 fx) was administered with a median treatment time of 18 min (13-25). No late side effects and new neurological deficits were observed in any case. At a median of 3 months (1-8), partial response was found to be 16% and stable response was 76%. At the last evaluation, local control was achieved in 88% of the cases. The mean and 2-year overall survival (OS) was 38.5 months and 96.2%. In univariate analysis, KPS ≥ 80 (1 year 100% vs 80%, p=0.04) and the presence of a solitary lesion (1 year 100% vs 66,7%, p =0.006) were found to be significant in terms of OS. CK-M6 increases patient compliance, and also reduces the risk of secondary cancer by reducing treatment duration and body dose. In our cases, 88% local control was achieved and CK-M6 based SRT was found to be effective, safe and comfortable.
This study aimed to evaluate the effectiveness and dosimetric features of meningioma patients who received stereotactic radiotherapy (SRT) with the CyberKnife-M6 (CK-M6) device in our department. Between January 2019 and February 2022, 31 lesions/26 cases were treated and evaluated in June 2022 with a median follow-up of 12 months (1-40). Median age was 56 (21-84), median KPS was 90 (40-100), and male/female ratio was 9/17. At diagnosis, there were multipl lesions in 4 patients and solitary lesions in 22 patients. Of the 17 patients who underwent surgery at least once, 65% were diagnosed with grade I meningioma and 35% with grade II meningioma. The median Ki-67 was 2.5% (0.8-35 %). There was a history of RT in five cases. The time from diagnosis to SRT was 28 months (1-244). The median lesion size before SRT was 22 mm (6-50) and the planning target volume was 8.24 cc (0.47-63.99). A median of 25 Gy/5 fractions (13-27 Gy/1-5 fx) was administered with a median treatment time of 18 min (13-25). No late side effects and new neurological deficits were observed in any case. At a median of 3 months (1-8), partial response was found to be 16% and stable response was 76%. At the last evaluation, local control was achieved in 88% of the cases. The mean and 2-year overall survival (OS) was 38.5 months and 96.2%. In univariate analysis, KPS ≥ 80 (1 year 100% vs 80%, p=0.04) and the presence of a solitary lesion (1 year 100% vs 66,7%, p =0.006) were found to be significant in terms of OS. CK-M6 increases patient compliance, and also reduces the risk of secondary cancer by reducing treatment duration and body dose. In our cases, 88% local control was achieved and CK-M6 based SRT was found to be effective, safe and comfortable.
Description
Bu çalışma, 18-19, Kasım 2022 tarihlerinde İstanbul[Türkiye]’de düzenlenen 13. Multidisipliner Nöroonkoloji Sempozyumu’nda bildiri olarak sunulmuştur.
Keywords
Stereotaktik radyoterapi, CyberKnife-M6, Lokal kontrol, Meningioma, Stereotactic radiotherapy, Local control
Citation
Daneshvar, A. vd. (2024).''Meningiomalarda stereotaktik radyoterapi: cyberknife-M6 deneyimi: retrospektif çalışma'' Uludağ Üniversitesi Tıp Fakültesi Dergisi, 50(1), 5-12.