46例脑转移瘤放射治疗分析

 目的 回顾性分析脑转移瘤采用单纯放射治疗（R）和放疗加化疗（R＋C）的治疗效果和影响预后因素。方法 对1992年8月至2004年7月，12年间收治的脑转移瘤中46例，进行回顾性观察分析。R组28例，首先行全脑放疗30～36Gy后，缩野加量至40～60Gy。R＋C组18例，首先行全脑放疗30Gy后，在缩野加量的同时，加VM-26100mg＋NS 500ml静脉点滴，每天1次，连用3天，第4天口服Me-CCNU 150～200mg，间隔6～8周重复化疗1次，共3～6周期，放疗总量仍为40～60Gy。结果 大于12个月的生存率和局部控制率R＋C组明显优于R组（P〈0．05）。原发肿瘤控制与否及其病理类型、颅外转移与疗效有明显相关性。结论 R＋C冶疗脑转移瘤在延长患者的生存期和局部控制方面明显优于R组。原发肿瘤控制与否及其病理类型、颅外转移对疗效有显著影响。如立体定向放射治疗（SRS）配合全脑照射，疗效会更满意。

Analysis of Radiotherapy for 46 Patients with Brain Metastasis

Objective 　To analyze the result of treatment with alone radiotherapy(R) and radiotherapy plus chemotherapy ( R + C ) and investigate it s prognostic factors for brain metastasis ret rospectively.Methods 　From August 1992 to July 2004 46 patients of brain metastasis were studied in 2 groups.Group R with 28 cases , whole brain irradiation were given with the dose 30～36 Gy first , then shrink the field and increase the dose to 40-60 Gy . Group R + C with 18 cases , give whole brain irradiation with the dose 30 Gy first , then reduce the field , in the same time , use the VM-26 100mg + N. S 500ml for iv drop ,qd for 3 days , and the Me-CCNU 150mg～200mg for oral on the fourth days , 6～8 week as circle , repeat for 3～6 circles , the totle dose of irradiation was still 40～60 Gy. Results 　The survival rate and local control rate of over 12 months in group R + C was better than group R ( P < 0. 05) . The relation with efficacy and extercranium metastasis , primary tumor is cont rolled or no and it s pathological type was obvious . Conclusion 　The R + C is superior to R in the prolong survival period and local cont rol rate in treatemt for the brain metastasis. The relation with efficacy and extercranium metastasis , primary tumor is cont rolled or no and it =s pathological type is significant prognostic factor for efficacy. If stereotactic radiosurgery combined with whole brain irradiation the result shall be best .