Küçük hücreli dışı akciğer kanserli beyin metastazlı hastalarda tüm beyin radyoterapisi sonrası klinik ve radyolojik yanıt değerlendirme

Öz

Amaç: Bu çalışmanın amacı beyin metastazlarının tüm beyin radyoterapisine (WBRT) yanıtını ve bu tedavinin bu yanıtı etkilemedeki rolünü değerlendirmektir. Gereç ve Yöntemler: Çalışmaya, tanı anında veya hastalık seyri sırasında beyin metastazları nedeniyle WBRT uygulanan on sekiz hasta dahil edildi. Manyetik rezonans görüntüleme (MRG) ve nörolojik muayeneler, WBRT tamamlandıktan 4-6 hafta ve 8-10 hafta sonra gerçekleştirildi. Bulgular: Radyolojik değerlendirmede, iki hastada (%17) tam yanıt, altı hastada (%50) kısmi yanıt ve dört hastada (%33) WBRT'den 8-10 hafta sonra stabil hastalık vardı. Soliter beyin metastazı olan iki hastanın lezyonu kayboldu ve multipl metastazı olan iki hastanın bir lezyonu WBRT'den 8-10 hafta sonra radyolojik olarak kayboldu. İlk ölçüm sırasında en büyük lezyonun çapı 0,6 ila 4,3 cm (ortalama 2,5 cm) iken, tüm beyin radyoterapisinden 8-10 hafta sonra buna karşılık gelen çap 0 ila 3,5 cm (ortalama 1,6 cm) idi. Tümör hacimleri değerlendirildiğinde, aralık 78 mm3 ile 623 mm3 arasındaydı. Tanı anındaki ve radyoterapi sonrası ilk manyetik rezonans görüntülemedeki hacimler karşılaştırıldığında, anlamlı yanıt oranı elde edildi (p=0,008). WBRT sonrası hastaların tamamında başlangıçtaki nörolojik semptom ve bulguların şiddetinin azaldığı veya kaybolduğu görüldü. Sonuç: Çalışmamızda, WBRT beyin metastazlı hastalarda nörolojik iyileşme sağlamış ve WBRT'den 8-10 hafta sonra, çoğu hastada lezyonların boyutunda ölçülebilir bir azalma meydana gelmiştir. Bu bulguların klinik faydasına odaklanan, daha uzun takip süreli ve daha fazla hasta içeren çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Akciğer kanseri
• beyin metastazı
• tüm beyin radyoterapisi
• cerrahi
• stereotaktik radyocerrahi

Clinical and radiological response assessment after whole brain radiotherapy for patients with non-small cell lung cancer with brain metastases

Öz

Aim: This study aims to evaluate the response of brain metastases to whole-brain radiotherapy (WBRT) and the role of this treatment in influencing that response. Material and Methods: The study involved eighteen patients who received WBRT for brain metastases either at the time of diagnosis or during the course of their disease. Magnetic resonance imaging (MRI) and neurological examinations were conducted 4 to 6 weeks and 8 to 10 weeks after the completion of WBRT. Results: According to our radiologic assessment, two patients (17%) had a complete response, six patients (50%) had a partial response, and four patients (33%) had stable disease 8-10 weeks after WBRT. The lesion of two patients with solitary brain metastasis vanished, and one lesion of two patients with multiple metastases radiologically disappeared at 8-10 weeks after WBRT. During the initial measurement, the diameter of the biggest lesion was 0.6 to 4.3 cm (average 2.5 cm), 8-10 weeks after whole brain radiotherapy, the corresponding diameter was 0 to 3.5 cm (average 1.6 cm). When the tumor volumes were evaluated, the range was between 78 mm3 and 623 mm3. The volumes at diagnosis and first magnetic resonance imaging after radiotherapy were compared, and a significant response rate was obtained (p=0.008). After WBRT, a decrease in intensity or disappearance of the initial neurological symptoms and signs was seen in all patients. Conclusion: In our study, WBRT provided a neurologic improvement in the patients with brain metastases, and 8-10 weeks after WBRT, a measurable reduction occurred in the size of the lesions in many of them. There is a need for studies with longer follow-ups and more patients focusing on the clinical utility of these findings.

Anahtar Kelimeler

• Lung cancer
• brain metastasis
• whole-brain radiotherapy
• surgery
• stereotactic radiosurgery

Kaynakça

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