Intracranial Autograft Fat Placement to Separate the Optic Chiasm from Tumor to Improve Stereotactic Radiotherapy Dosimetry.

Autor: Turner BE; Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA., Schüler E; Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA., Chang SD; Department of Neurosurgery, Stanford School of Medicine, Stanford, California, USA., Harsh GR; Department of Neurosurgery, University of California, Davis, Davis, California, USA., Soltys SG; Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA. Electronic address: sgsoltys@stanford.edu.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2021 Feb; Vol. 146, pp. 80-84. Date of Electronic Publication: 2020 Oct 29.
DOI: 10.1016/j.wneu.2020.10.110
Abstrakt: Background: Radiation therapy for intracranial lesions is constrained by dose to neurologic organs at risk.
Case Description: We report 2 cases, a newly diagnosed chondrosarcoma and a previously irradiated meningioma, with tumors that abutted the optic chiasm following subtotal resection. Definitive radiotherapy would have required either undercoverage of the tumor or treatment of the chiasm with doses posing an unacceptable risk of blindness. Therefore, the patients underwent open surgery with placement of an abdominal fat autograft to provide space between the tumor and the optic structures at risk. Patients received definitive fractionated stereotactic radiotherapy. For each patient, we retrospectively compared the treated plan (with fat autograft) to a second plan generated using the pre-autograft imaging, maintaining similar tumor coverage. For the chondrosarcoma, the fat autograft reduced the optic chiasm maximum dose by 21% (70.4 Gy to 55.3 Gy). For the reirradiated peri-optic meningioma, the optic chiasm maximum dose was reduced by 10% (50.8 Gy to 45.9 Gy), the left optic nerve by 17% (48.9 Gy to 40.4 Gy), and the right optic nerve by 30% (32.3 Gy to 22.6 Gy).
Conclusions: We demonstrate the utility of abdominal fat autograft placement to maximize coverage of tumor while minimizing dose to intracranial organs at risk.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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