Metástase cerebral: tratamento paliativo com radiocirurgia

Faria, Sérgio L.; Souhami, Luis; Bahary, Jean-Paul; Caron, Jean-Louis; Villemure, Jean-Guy; Olivier, André; Clark, Brenda; Podgorsak, Ervin B.

doi:10.1590/S0004-282X1995000400004

Resumos

O artigo faz avaliação de 52 pacientes com metástase cerebral tratados com radiocirurgia estereotática na Universidade McGill, em Montreal. A radiocirurgia foi realizada com a técnica dinâmica em que, ao mesmo tempo, giram a mesa e a cabeça do acelerador linear de 10 MV. Todos os pacientes (56 tratamentos ao todo) foram tratados com um único isocentro e uma dose única mediana de 1800 cGy na periferia da metástase. Em 88% dos casos a radiocirurgia foi usada após falha de tratamento radioterápico fracionado em todo cérebro. Todos os 52 casos tiveram avaliação com CT pós radiocirurgia. O seguimento mediano foi de 6 meses (variou entre 1 e 37 meses) e a taxa de resposta, parcial ou completa, foi de 64%. Apenas 4 pacientes (7%) tiveram algum tipo de complicação tardia relacionada ao tratamento. Estes achados vão de encontro com dados da literatura. A radiocirurgia é tratamento pouco agressivo, bem tolerado e com alta taxa de resposta para lesões locais e pode ser útil para pacientes selecionados. O seu valor definitivo, como tratamento único ou combinado com radioterapia em todo cérebro, está sendo avaliado de forma prospectiva e randomizada.

radiocirurgia estereotática; metástase cerebral; tratamento paliativo

This is a retrospective review of 52 patients with metastatic brain disease who underwent stereotactic radiosurgery at McGill University in Montreal. The radiosurgical treatment was performed with the dynamic rotation technique in which there is continuous and simultaneous movement of treatment couch and machine gantry of a 10 MV linac. All patients were treated with a single isocenter and a median dose of 1800 cGy was delivered. In 88% of the cases radiosurgery was given after failure from whole brain conventional irradiation. All 52 cases were assessed with brain CT post radiosurgery. The median follow up time was 6 months (range 1 -37 months) and the response rate (partial or complete) was 64%. Only 4 patientes (7%) developed late complications related to the treatment. These findings are similar to the literature. Stereotactic radiosurgery is a well tolerated, effective and minimally invasive treatment technique which has a high response rate in selected patients with small, well delineated metastatic brain lesion. Its definitive value as a single therapy or combined with whole brain conventional radiotherapy is being studied in prospective and randomized trials.

radiosurgery; brain metastases; palliative treatment

Metástase cerebral. Tratamento paliativo com radiocirurgia

Brain metastasis: palliative treatment with radiosurgery

Sérgio L. Faria; Luis Souhami; Jean-Paul Bahary; Jean-Louis Caron; Jean-Guy Villemure; André Olivier; Brenda Clark; Ervin B. Podgorsak

Departamentos de Oncologia (Divisão de Radioterapia) e Neurocirurgia McGill University, Montreal, Canada. Dr. Sérgio L. Faria era Fellow da UlCC-União Internacional Contra o Câncer, no projeto "International Cancer Technology Transfer" (ICRETT) durante a realização deste estudo

RESUMO

O artigo faz avaliação de 52 pacientes com metástase cerebral tratados com radiocirurgia estereotática na Universidade McGill, em Montreal. A radiocirurgia foi realizada com a técnica dinâmica em que, ao mesmo tempo, giram a mesa e a cabeça do acelerador linear de 10 MV. Todos os pacientes (56 tratamentos ao todo) foram tratados com um único isocentro e uma dose única mediana de 1800 cGy na periferia da metástase. Em 88% dos casos a radiocirurgia foi usada após falha de tratamento radioterápico fracionado em todo cérebro. Todos os 52 casos tiveram avaliação com CT pós radiocirurgia. O seguimento mediano foi de 6 meses (variou entre 1 e 37 meses) e a taxa de resposta, parcial ou completa, foi de 64%. Apenas 4 pacientes (7%) tiveram algum tipo de complicação tardia relacionada ao tratamento. Estes achados vão de encontro com dados da literatura. A radiocirurgia é tratamento pouco agressivo, bem tolerado e com alta taxa de resposta para lesões locais e pode ser útil para pacientes selecionados. O seu valor definitivo, como tratamento único ou combinado com radioterapia em todo cérebro, está sendo avaliado de forma prospectiva e randomizada.

Palavras-chave: radiocirurgia estereotática, metástase cerebral, tratamento paliativo.

SUMMARY

This is a retrospective review of 52 patients with metastatic brain disease who underwent stereotactic radiosurgery at McGill University in Montreal. The radiosurgical treatment was performed with the dynamic rotation technique in which there is continuous and simultaneous movement of treatment couch and machine gantry of a 10 MV linac. All patients were treated with a single isocenter and a median dose of 1800 cGy was delivered. In 88% of the cases radiosurgery was given after failure from whole brain conventional irradiation. All 52 cases were assessed with brain CT post radiosurgery. The median follow up time was 6 months (range 1 -37 months) and the response rate (partial or complete) was 64%. Only 4 patientes (7%) developed late complications related to the treatment. These findings are similar to the literature. Stereotactic radiosurgery is a well tolerated, effective and minimally invasive treatment technique which has a high response rate in selected patients with small, well delineated metastatic brain lesion. Its definitive value as a single therapy or combined with whole brain conventional radiotherapy is being studied in prospective and randomized trials.

Key words: radiosurgery, brain metastases, palliative treatment.

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Aceite: 14 -abril -1995.

Dr Sérgio L. Faria - Hospital Municipal Dr. Mario Gatti, Radioterapia - Av. Pref. Faria Lima 340 - 13036-902 Campinas SP - Brasil.

1. Adler JR, Cox RS, Kaplan I, Martin DP. Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 1992; 76:444-449.
2. Borget B, Gelber R, Kramer S et al. The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Study Group. Int J Radiat Oncol Biol Phys 1980; 6:1-9.
3. Cairncross JG, Posner JB. The management of brain metastases. In Walker MD (ed). Oncology of the nervous system. Vol 12 of Cancer Treatment Research. Boston: Martinus Nijhoff, 1983, p341-347.
⁴
Câncer no Brasil. Dados dos Registros de Base Populacional. Rio de Janeiro: Ministério da Saúde, Instituto Nacional do Câncer, 1991.
5. De Angelis LM. Management of brain metastases. Cancer Invest 1994; 12:156-165.
6. Flickinger JC, Kondziolka D, Lunsford LD et al. A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncology Biol Phys 1994; 28:797-802.
7. Fuller BG, Kaplan ID, Adler JR et al. Stereotaxic radiosurgery for brain metastases: the importance of adjuvant whole brain irradiation. Int J Radiat Oncol Biol Phys 1992; 23:413-418.
8. Galicich JH, Sundaresan N. Metastatic brain tumors. In Wilkins RH, Rengachary SS (eds). Neurosurgery. New York: McGraw-Hill, 1985, p597-610.
9. Kaplan EL, Meier P. Non parametric estimations from incomplete observations. J Am Stat Assoc 1953; 53:457-480.
10. Larson DA, Bova F, Eisert D et al. Current radiosurgery practice: results of an ASTRO survey. Int J Radiat Oncol Biol Phys 1994; 28:523-526.
11. Leksell L. The sterotaxis method and radiosurgery of the brain. Acta Scand 1951; 102:316-319.
12. McKenzie MR, Souhami L, Caron JL et al. Early and late complications following dynamic stereotactic radiosurgery and fractionated stereotactic radiotherapy. Can J Neurol Sci 1993; 20:279-285.
13. Metha MP, Rozenthal JM, Levin AB et al. Defining the role of radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 1992;24:619-625.
14. Patchell RA, Tibbs PA, Walsh JW et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322:494-500.
15. Podgorsak EB, Olivier A, Pia M, Lefebvre PY, Hazel J. Dynamic stereotactic radiosurgery. Int J Radiat Oncology Biol Phys 1988; 14:115-125.
16. Podgorsak EB, Pike GB, Olivier A, Pia M, Souhami L. Radiosurgery with high energy photon beams: a comparison among techniques. Int J Radiat Oncol Biol Phys 1989; 16: 857-865.
17. Souhami L, Olivier A, Podgorsak EB et al. Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 1990; 19:775-782.
18. Souhami L, Podgorsak EB. Radiocirurgia estereotática. Radiol Bras 1990; 23:49-58.
19. Smaley SR, Schray MF, Laws ER, O'Fallon Jr. Adjuvant radiation therapy after surgical resection of solitary brain metastasis: association with patterns of failure and survival. Int J Radiat Oncol Biol Phys 1987; 13:1611-1616.
20. Sturm V, Kober B, Hover KL et al. Stereotactic percutaneous single dose irradiation of brain metastases with a linear accelerator. Int J Radiat Oncol Biol Phys 1987; 13:279-282
21. Sze G, Shin J, Krol G et al. Intraparenchymal brain metastases: MR imaging versus contrast enhanced CT. Radiology 1988; 168:187-194.
22. Winston KR, Walsh JW, Fisher EG. Results of operative treatment of intracranial metastatic tumors. Cancer 1980; 45:2639-2645.
23. Wright DC, Delaney TF, Buckner JC. Treatment of metastatic cancer to the brain. In DeVitta VT Jr, Hellman S, Rosemberg SA. Cancer: principles and practice of oncology. Ed. 4 Philadelphia: JB Lipincott 1993, p2170-2186.

Datas de Publicação

Publicação nesta coleção
20 Dez 2010
Data do Fascículo
Set 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adler JR, Cox RS, Kaplan I, Martin DP. Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 1992; 76:444-449.

[2] 2. Borget B, Gelber R, Kramer S et al. The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Study Group. Int J Radiat Oncol Biol Phys 1980; 6:1-9.

[3] 3. Cairncross JG, Posner JB. The management of brain metastases. In Walker MD (ed). Oncology of the nervous system. Vol 12 of Cancer Treatment Research. Boston: Martinus Nijhoff, 1983, p341-347.

[4] ⁴
Câncer no Brasil. Dados dos Registros de Base Populacional. Rio de Janeiro: Ministério da Saúde, Instituto Nacional do Câncer, 1991.

[5] 5. De Angelis LM. Management of brain metastases. Cancer Invest 1994; 12:156-165.

[6] 6. Flickinger JC, Kondziolka D, Lunsford LD et al. A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncology Biol Phys 1994; 28:797-802.

[7] 7. Fuller BG, Kaplan ID, Adler JR et al. Stereotaxic radiosurgery for brain metastases: the importance of adjuvant whole brain irradiation. Int J Radiat Oncol Biol Phys 1992; 23:413-418.

[8] 8. Galicich JH, Sundaresan N. Metastatic brain tumors. In Wilkins RH, Rengachary SS (eds). Neurosurgery. New York: McGraw-Hill, 1985, p597-610.

[9] 9. Kaplan EL, Meier P. Non parametric estimations from incomplete observations. J Am Stat Assoc 1953; 53:457-480.

[10] 10. Larson DA, Bova F, Eisert D et al. Current radiosurgery practice: results of an ASTRO survey. Int J Radiat Oncol Biol Phys 1994; 28:523-526.

[11] 11. Leksell L. The sterotaxis method and radiosurgery of the brain. Acta Scand 1951; 102:316-319.

[12] 12. McKenzie MR, Souhami L, Caron JL et al. Early and late complications following dynamic stereotactic radiosurgery and fractionated stereotactic radiotherapy. Can J Neurol Sci 1993; 20:279-285.

[13] 13. Metha MP, Rozenthal JM, Levin AB et al. Defining the role of radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 1992;24:619-625.

[14] 14. Patchell RA, Tibbs PA, Walsh JW et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322:494-500.

[15] 15. Podgorsak EB, Olivier A, Pia M, Lefebvre PY, Hazel J. Dynamic stereotactic radiosurgery. Int J Radiat Oncology Biol Phys 1988; 14:115-125.

[16] 16. Podgorsak EB, Pike GB, Olivier A, Pia M, Souhami L. Radiosurgery with high energy photon beams: a comparison among techniques. Int J Radiat Oncol Biol Phys 1989; 16: 857-865.

[17] 17. Souhami L, Olivier A, Podgorsak EB et al. Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation. Int J Radiat Oncol Biol Phys 1990; 19:775-782.

[18] 18. Souhami L, Podgorsak EB. Radiocirurgia estereotática. Radiol Bras 1990; 23:49-58.

[19] 19. Smaley SR, Schray MF, Laws ER, O'Fallon Jr. Adjuvant radiation therapy after surgical resection of solitary brain metastasis: association with patterns of failure and survival. Int J Radiat Oncol Biol Phys 1987; 13:1611-1616.

[20] 20. Sturm V, Kober B, Hover KL et al. Stereotactic percutaneous single dose irradiation of brain metastases with a linear accelerator. Int J Radiat Oncol Biol Phys 1987; 13:279-282

[21] 21. Sze G, Shin J, Krol G et al. Intraparenchymal brain metastases: MR imaging versus contrast enhanced CT. Radiology 1988; 168:187-194.

[22] 22. Winston KR, Walsh JW, Fisher EG. Results of operative treatment of intracranial metastatic tumors. Cancer 1980; 45:2639-2645.

[23] 23. Wright DC, Delaney TF, Buckner JC. Treatment of metastatic cancer to the brain. In DeVitta VT Jr, Hellman S, Rosemberg SA. Cancer: principles and practice of oncology. Ed. 4 Philadelphia: JB Lipincott 1993, p2170-2186.