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.