脑转移瘤放射治疗局部推量模式的临床分析

目的探讨全脑放射治疗(WBRT)分别联合调强适形放射治疗(IMRT)与联合立体定向放射治疗(SRT)对非小细胞肺癌(NSCLC)1³个脑转移瘤病灶疗效的比较。方法将2010年1月至2011年12月收治的非小细胞肺癌脑转移患者80例,随机分为WBRT加IMRT组(38例)和WBRT加SRT组(42例),以中位生存时间、局部控制率、1年生存率和周围器官受量等作为评价指标,对两种方法进行疗效与组织损伤的评价和比较。结果 WBRT加IMRT组和WBRT加SRT组的中位生存时间分别为10.6月和11.9月(P=0.144);局部率控制分别为73.7%和90.5%(P=0.002);1年生存率分别为68.4%和81.0%(P=0.070);单个转移灶者1年生存率分别为78.6%和90.0%,23个脑转移瘤病灶疗效的比较。方法将2010年1月至2011年12月收治的非小细胞肺癌脑转移患者80例,随机分为WBRT加IMRT组(38例)和WBRT加SRT组(42例),以中位生存时间、局部控制率、1年生存率和周围器官受量等作为评价指标,对两种方法进行疗效与组织损伤的评价和比较。结果 WBRT加IMRT组和WBRT加SRT组的中位生存时间分别为10.6月和11.9月(P=0.144);局部率控制分别为73.7%和90.5%(P=0.002);1年生存率分别为68.4%和81.0%(P=0.070);单个转移灶者1年生存率分别为78.6%和90.0%,2³个脑转移灶者分别为37.5%和55.6%,两种治疗方法差异无统计学意义(P=0.226);脑干最大受量(D max)分别为(275±285)Gy和(17±25)Gy,平均受量(D mean)分别为(144±152)Gy和(9±14)Gy,差异均有统计学意义(均P=0.000)。结论全脑放射治疗后行立体定向放射治疗局部加量能更好地提高病人的局部控制率,对周围组织损伤更小。

The clinical analysis of local dosage of radiotherapy for brain metastatic tumor

Objective To compare the treatment results of intensity modulated radiation therapy （IMRT） or stereotactic radiotherapy （SRT） in the management of one to three brain metastatic lesions of non-small cell lung cancer （NSCLC） after whole brain irradiation. Methods From 2010 January to 2011 December, 80 NSCLC patients with 1-3 brain metastatic lesions were treated with IMRT or SRT after whole brain irradiation. 38 cases with IMRT and 42 cases with SRT were enrolled. The one year survival, local control rate and overall survival were studied. Results The median survival time of IMRT group SRT group were 10. 6 months, 11.9months respectively （P =0. 144） ;Local control rate were 73.7% and 90. 5% respectively （P =0. 002） ; 1 year survival rate were 68. 4% and 81.0% respectively （P =0. 070） ; The one year survival rate of a single metastases were 78.6% and 90.0% respectively, two to three brain metastases were 37. 5% and 55.6% respectively, two kinds of treatment showed no statistical difference （P = 0. 226）. The maximum injectivity of brain stem were（275 ±285） Gy and （17 ±25） Gy respectively （P = 0. 000） ; the average injectivity were respectively for （ 144 ± 152） Gy and （9 ± 14） Gy （P =0. 000）. Con- clusions Stereotactic radiotherapy after whole brain radiation improved local control and quality of life in patients with 1-3 brain metastatic lesions of NSCLC, and also prevented unnecessary irradiation on the surrounding brain tissues.