ИСТОРИЯ РАЗВИТИЯ СТЕРЕОТАКСИЧЕСКОЙ РАДИОХИРУРГИИ И ЕЕ РОЛЬ В ЛЕЧЕНИИ МЕТАСТАЗОВ В ГОЛОВНОЙ МОЗГ

У 20–40 % онкологических пациентов происходит метастазирование первичных опухолей в головной мозг. В статье приведена историческая справка о возникновении и развитии метода стереотаксической радиохирургии (СРХ), в том числе Гамма-ножа и Киберножа. Становление новых центров радиохирургии в мире делает этот метод более доступным для пациентов. Рассматривается современный алгоритм лечения церебральных метастазов и роль метода как средства конформного аблативного высокодозного лечения отдельных метастатических очагов в ведении таких больных. Показано, что радиохирургия обеспечивает высокий уровень локального контроля и демонстрирует аналогичную выживаемость пациентов по сравнению с хирургической резекцией.

Проанализированы результаты исследований по сочетанию СРХ с тотальным облучением головного мозга у пациентов с солитарным и множественными поражениями. Показано, что применение радиохирургии позволяет избежать тотального облучения как при солитарных метастазах, так и у больных с множественными метастазами, без влияния на выживаемость, что, предположительно, позволяет сохранить нейрокогнитивные функции и качество жизни пациентов с хорошим общим состоянием по шкале Карновского (индекс ³ 70). Также обсуждается возможность проведения стереотаксического облучения на послеоперационную полость. Понятие радиохирургии не разделяется в зависимости от используемой для проведения лечения платформы.

DOI: 10.17650/2222-1468-2015-1-27-35

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