立体定向伽玛刀放射外科治疗肺癌脑转移瘤的疗效分析

目的:探讨伽玛刀治疗肺癌脑转移瘤的临床疗效及不良反应。方法:选择伽玛刀治疗肺癌脑转移瘤患者236 例，根据病变大小和部位选用4-18mm 准直器靶点，肿瘤边缘剂量12-22Gy，平均17Gy，中心剂量32-40Gy，平均35.4Gy，边缘等剂量曲线40%-75％，平均58％。 结果:对全部患者伽玛刀治疗后进行临床随访，视具体情况1-3 个月复查影像，随访时限不少于半年；6个月、12个月患者生存率，腺癌患者分别为69.1％（56/81）、38.3％（31/81），鳞癌患者为60.0％（45/75）、20.0％（15/75），小细胞癌患者则为62.7％（37/59）、27.1％（16/59）；伽玛刀治疗后1-3个月随访KPS评分，提高128 例（54.2％），不变81 例（34.3％），下降27例（11.4％）。腺癌、鳞癌、小细胞癌、鳞腺混合癌脑转移瘤局部控制有效率分别为87.7％（71/81）、93.3％（70/75）、100％（59/59）、85.7％（18/21）。无1例患者出现严重脑水肿而终止放疗，无1例患者出现严重骨髓功能抑制。 结论:伽玛刀治疗肺癌脑转移瘤具有疗效好、安全的优势，能有效提高脑转移瘤患者生活质量，延长生存期。

Therapeutic effect of gamma knife of stereotactic radiotherapy for lung cancer with brain metastasis

Objective:To investigate the clinical efficacy and adverse reactions of gamma knife radiosurgery for brain metastases of lung cancer.Methods:All 236 cases of metastasis tumor in patients with lung cancer with brain were treated with gamma knife，selection of 4-18mm collimator target according to lesion size and position，the tumor margin dose of 12-22Gy，average 17Gy，central dose of 32-40Gy，average 35.4Gy，edge isodose curve 40%-75%，with an average of 58%.Results:The follow-up for all patients after treatment was not less than half a year.6 months，12 months survival rates were 69.1%(56/81)，38.3%(31/81)，squamous cell carcinoma was 60%(45/75)，20%(15/75)，small cell carcinoma was 62.7%(37/59)，27.1%(16/59)；Gamma knife treatment after 1-3 months of follow-up KPS score，128 cases were improved (54.2%)，remained unchanged in 81 cases (34.3%)，decreased by 27 (11.4%).The local control rates were 87.7% in adenocarcinoma，squamous cell carcinoma，small cell carcinoma，adenosquamous mixed cancer brain metastasis 87.7%(71/81)，93.3%(70/75)，100%(59/59)，85.7%(18/21).There were no cases of severe cerebral edema no cases of severe bone marrow suppression.Conclusion:Gamma knife radiosurgery for brain metastases of lung cancer has good efficacy，safe，can effectively improve the quality of life of patients with brain metastatic tumor，prolong the survival period.