neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2021-23-1-26-37neurosurgery-1009Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTСтажированная радиохирургия в лечении пациентов с метастатическим поражением головного мозгаStaged radiosurgery in the managment of patients with brain metastasesОсиновИ. К.OsinovI. K.

Иван Константинович Осинов

Россия, 125047 Москва, ул. 4‑я Тверская-Ямская, 16, корп. 3

Ivan Konstantinovich Osinov

Bld. 3, 16 4 th Tverskaya-Yamskaya St., Moscow 125047, Russia

IOsinov@nsi.ruhttps://orcid.org/0000-0002-0976-4547ГолановА. В.GolanovA. V.

Россия, 125047 Москва, ул. 4‑я Тверская-Ямская, 16

16 4 th Tverskaya-Yamskaya St., Moscow 125047, Russia

https://orcid.org/0000-0002-7167-7989БановС. М.BanovS. M.

Россия, 125047 Москва, ул. 4‑я Тверская-Ямская, 16, корп. 3

Россия, 125047 Москва, ул. 4‑я Тверская-Ямская, 16

Bld. 3, 16 4 th Tverskaya-Yamskaya St., Moscow 125047, Russia

16 4 th Tverskaya-Yamskaya St., Moscow 125047, Russia

АртеменковаА. Е.ArtemenkovaA. E.

Россия, 125047 Москва, ул. 4‑я Тверская-Ямская, 16, корп. 3

16 4 th Tverskaya-Yamskaya St., Moscow 125047, Russia

КостюченкоВ. В.KostuchenkoV. V.

Россия, 125047 Москва, ул. 4‑я Тверская-Ямская, 16, корп. 3

16 4 th Tverskaya-Yamskaya St., Moscow 125047, Russia

https://orcid.org/0000-0003-0782-0821ДалечинаА. В.DalechinaA. V.

Россия, 125047 Москва, ул. 4‑я Тверская-Ямская, 16, корп. 3

16 4 th Tverskaya-Yamskaya St., Moscow 125047, Russia

АО «Деловой центр нейрохирургии» (Центр «Гамма-нож»)РоссияBusiness Center of Neurosurgery (Gamma Knife Center)Russian FederationФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. Н. Н. Бурденко» Минздрава РоссииРоссияN.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of RussiaRussian FederationАО «Деловой центр нейрохирургии» (Центр «Гамма-нож»); ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. Н. Н. Бурденко» Минздрава РоссииРоссияBusiness Center of Neurosurgery (Gamma Knife Center); N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of RussiaRussian Federation20210305202123126‑37Copyright © Осинов И.К., Голанов А.В., Банов С.М., Артеменкова А.Е., Костюченко В.В., Далечина А.В., 20212021Осинов И.К., Голанов А.В., Банов С.М., Артеменкова А.Е., Костюченко В.В., Далечина А.В.Osinov I.K., Golanov A.V., Banov S.M., Artemenkova A.E., Kostuchenko V.V., Dalechina A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1009

Цель исследования – изучить эффективность стажированной радиохирургии на аппарате «Гамма-нож» у пациентов с метастатическим поражением головного мозга.

Материалы и методы

Материалы и методы. В ретроспективный анализ включен 31 пациент (13 мужчин и 18 женщин) с метастатическим поражением головного мозга, радиохирургическое лечение которых проведено за 2 сеанса. Операция была противопоказана всем пациентам из‑за риска развития неврологического дефицита или из‑за высокого анестезиологического риска.

Результаты

Результаты. Локальный контроль роста метастазов через 3 мес после лечения достигнут в 31 (96,9 %) из 32 очагов, через 6 и 12 мес – в 92,5 и 83,8 % соответственно. Возраст пациентов <50 лет ассоциировался с более высокой выживаемостью без прогрессирования. Медиана времени возникновения лучевых осложнений I–II степени составила 3,0 мес, осложнения наблюдались у 11 (45,8 %) из 24 пациентов. Лучевые осложнения II степени (перифокальный отек) и наблюдались у 8 (33,3 %) пациентов, III степени (радионекроз) – у 2 (8,3 %) пациентов. Общая выживаемость в сроки 6 и 12 мес составила 55,6 и 40,8 % соответственно (медиана 6,9 мес), в подгруппе пациентов, получавших противоопухолевое лекарственное лечение, – 80,0 и 56,8 % соответственно. Все пациенты, не проходившие противоопухолевое лекарственное лечение, умерли в срок до 6 мес.

Заключение

Заключение. Стажированное радиохирургическое лечение с интервалом в 2–4 нед между сеансами обеспечивает удовлетворительные показатели локального контроля с приемлемым уровнем постлучевых осложнений. Данный метод лечения может применяться у пациентов с крупными метастазами в головном мозге, не подлежащими хирургическому лечению.

The study objective is to present the results of the treatment of metastatic brain patients by the staged radiosurgery with the Gamma Knife.

Materials and methods

Materials and methods. The retrospective analysis included 31 patients (13 men and 18 women) with brain metastases, whose radiosurgery treatment was carried out in 2 sessions. The operation was contraindicated in all patients due to the risk of neurological deficits or due to the high anesthesiological risk.

Results

Results. Local control of metastases growth was achieved in 31 (96.9 %) of 32 foci 3 months after treatment, and in 92.5 and 83.8 %, after 6 and 12 months, respectively. The age <50 years were associated with higher progression-free survival respectively. The median time of grade I–II radiation complications was 3.0 months, complications were observed in 11 (45.8 %) of 24 patients. Radiation complications of grade II (perifocal edema) were observed in 8 (33.3 %) patients, grade III (radionecrosis) – in 2 (8.3 %) patients. Overall survival at 6 and 12 months was 55.6 and 40.8 %, respectively (median 6.9 months), in patients receiving antitumor drug treatment – 80.0 and 56.8 %, respectively. All patients who did not received antitumor drug therapy died within 6 months.

Conclusion

Conclusion. Two-stage radiosurgery, carried out in 2 sessions with an interval of 2–4 weeks, provides satisfactory local control with an acceptable level of post-radiation complications. This method of treatment can be used in patients with large brain metastases who are not subject to surgical treatment.

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The authors declare that there are no conflicts of interest present.