Objective: To evaluate the treatments’ outcomes in brain metastatic tumors after CyberKnife treatment according to magnetic resonance imaging (MRI) findings and improvement of symptoms. Methods: A retrospective analysis of CyberKnife treatment; 63 cases of patients with brain metastases; the use of CyberKnife treatment; short-term outcome evaluation after treatment and the MRI findings and measured before treatment and underwent diffusion-weighted imaging MRI scan of apparent diffusion coefficient (ADC) values. Results: 3 months after CyberKnife treatment and effectiveness were 82.5% and 96.8% respectively; 6 months and one year survival rates were 82.5% and 55.6% respectively; the median survival time was 16 months. MRI of 52 patients (67 lesions) ADC values after treatment increased to some extent than before treatment. There are 38 lesions volume to shrink or disappear, no enhancement or slight enhancement in the lesion, no edema zone; 27 lesions does not change in volume, no edema (18 lesions significantly weakened the degree of enhancement; 6 lesions showed no obvious change enhancement; 3 lesions showed ring enhancement, internal cystic); 2 lesions volume were larger, heterogeneous enhancement, peripheral edema. Conclusion: CyberKnife is an effective method for treating brain metastatic tumor. MRI can accurately evaluate tumor lesions after treatment.
Extracranial malignant brain metastases are involved in the brain, skull and meninges, brain metastasis mostly in the lower part of the cerebral cortex and cortex, followed by the cerebellum, saddle area, cerebellopontine angle and brainstem.
Meningeal metastasis occurs on the inside of dura mater and pia mater. Common primary tumors of brain metastases include lung cancer, breast cancer, digestive tract, urinary tract and uterine ovarian tumor, thyroid, malignant melanoma, etc. Up to their primary tumor histological type is adenocarcinoma, followed by squamous cell carcinoma, papillary carcinoma and melanoma. More than 70% of brain metastases associated with neurological aspects of clinical signs and symptoms, followed by poor positioning and mental disorders and other symptoms. Treatment of brain metastases includes hormone therapy, whole brain radiation therapy, surgery and chemotherapy. At present, the radiation therapy plays an important role in the treatment of brain metastases tumor. The CyberKnife has as many as 1200 beams, and through the tumor from various angles, can increase the exposure dose of tumor site and minimize the normal tissue dose of illuminated, while increasing the tumor dose rate effectively reduces the complications of radiotherapy. CyberKnife is a new and sustainable use of image-guided robotics technology. Mobile features correspond exactly to the position of the patient radiation delivery system. CyberKnife’s 6D skull tracking technology can take advantage of features in the healing process of bone sustained treatment of intracranial target tracking and automatically correcting even the most subtle movement and twisting will not miss. Now in our hospital 63 patients with brain metastases were treated with CyberKnife, and the results will now report as follows.
Select from November 2010 to December 2012 were treated brain CyberKnife treatment 63 cases of metastases patients, including 41 males and 22 females, aged 31 to 82 years, with an average age of 58 years; primary foci for lung cancer 43 cases; 11 cases of gastrointestinal cancer; breast cancer seven cases; 2 cases of lymphoma. Before treatment, KPS score < 70 points 11 cases; ≥ 70 points 52 cases. All brain metastases were confirmed by CT and MRI, in which single lesion in 48 cases; two lesions in six cases; three or more lesions in nine cases, a total of 98 brain metastases, tumor diameter of 0.8 - 8.8 cm , the average diameter of 3.1 cm . 52 patients (67 lesions) before treatment and MRI scan width San weighted imaging and measuring the apparent diffusion coefficient (ADC) values of the tumor region underwent treatment. Among them 53 cases of patients with tumor size, shape, location different, showing a headache, dizziness, nausea, vomiting, limb disorders, language disorders, memory losses and vision losses, such as different symptoms, clinical symptoms and the remaining ten patients were not obvious.
Patients with supine position, using hot mold fixed, cranial CT, MRI scan, CT scan slice thickness 1.25 mm , MRI slice thickness 2.5 mm , axial uninterrupted scan, determine the size of the lesion, shape and position of the transmission to the radio wave knife workstation to CT image-based, the CT image and MRI image fusion. Sketched by the physician in the treatment planning system target, then make plans by the physical division, and finally approved by a physician. Tumor volume of 15 - 35 Gy, divided into 1 to 5 times with 70% to 80% isodose curve more than 95% of tumor volume. Including 12 patients underwent whole brain radiation therapy, 35 patients with chemotherapy treatment. This clinical trial was approved by the Institutional Ethics Committee and all the patients provided written informed consent.
1) Symptoms improve evaluation standard: 1 week after treatment for clinical evaluation. Complete remis- sion: No clinical positive performance after treatment; Partial remission: After treatment, the clinical symptoms are mild; Stable: No obvious clinical improvement after treatment; Increase: Clinical symptoms get worse after treatment. To (complete remission and remission) computing efficiency improvement of symptoms.
2) Recent radiological lesions Response Evaluation Criteria: Radiotherapy after 1 month review head CT or MRI, According to the WHO solid tumor treatment evaluation standard(RECIST) [
1) Short term effect: After one week of CyberKnife treatment, the clinical symptoms resolved 46 cases, 14 cases of partial remission, stable three cases, symptoms improved efficiency of 95.2%. CyberKnife treatment of three months efficacy evaluation, CR 33 cases, PR 19 cases, SD 9 cases, PD 2 cases, treatment improved 82.5% effective rate of 96.8%. MRI was performed in 52 patients (67 lesions) were lower than before treatment ADC values corresponding contralateral normal tissue after treatment, review of ADC values higher than before treat- ment to varying degrees. MRI was performed in 67 lesions, 38 lesions volume to shrink or disappear, no en- hancement or slight enhancement of lesions, no significant edema zone surrounding lesions; 27 lesions had no obvious change in the surrounding volume, no significant edema area, of which 18 lesions degree of enhance- ment significantly weakened, no obvious change in 6 lesions degree of enhancement, 3 lesions showed ring en- hancement, internal cystic lesions; 2 volumes are increased, which showed heterogeneous enhancement, peripheral edema zone.
2) Survival and follow-up: Follow-up to January 2014, six-month survival rate was 82.5% (52 cases); 1-year survival rate was 55.6% (35 cases); the median survival time was 16 months.
In recent years, with the improvement of radiation therapy technology, whole brain radiation therapy has become a routine treatment for brain metastases. Whole Brain radiation therapy can not only improve brain metastases had a median survival time from 1 to 2 months symptomatic treatment alone increased to four to six months, but also can improve the quality of life of patients [
Gamma knife for the treatment of brain metastases tumor local control is 81% - 100%, but gamma knife treatment of patients with brain metastases need to install a fixed frame of the head, to increase the patient’s pain and sufferings, and only a single treatment [
Young et al. [
It is difficult to determine the nature of the lesions without obvious clinical symptoms and MRI showed pro- gression [
CyberKnife is an effective method for the treatment of brain metastases; MRI enhances scan and ADC values measurements help assess the efficacy of brain metastases, which is worthy of further promotion.
Jiashou Hu,Hongzi Tian,Na Guo,Di Wang,Jinfeng Sun, (2016) Evaluation of Magnetic Resonance Imaging Findings and Short-Term Outcome in Brain Metastatic Tumors after CyberKnife Treatment. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology,05,96-99. doi: 10.4236/ijmpcero.2016.51010