立体定向放射治疗肺癌脑转移疗效分析

目的探讨不同放射治疗方法对肺癌脑转移的疗效.方法176例由病理学证实的肺癌脑转移患者分为4组:单纯全脑放疗(WBRT)组、全脑放疗加立体定向放射外科(WBRT SRS)组、单纯立体定向放射治疗(SRT)组、全脑放疗加立体定向放射治疗(WBRT SRT)组.SRS治疗单次靶区平均周边剂量8～20Gy,总剂量20～32Gy;SRT治疗单次靶区平均周边剂量2～5Gy,总剂量25～60Gy;WBRT1.8～2Gy/次,总剂量30～40Gy.结果四组的局部控制率分别为47.0%、87.7%、86.5%和78.0%;中位生存期分别为5.0,11.0,11.5和10.0个月;局部无进展生存期分别为3.33,8.33,9.33和7.67个月;颅脑无新病灶生存期分别为4.11,8.57,9.03和6.12个月.在死因分析中,WBRT组死于脑转移的比率为57.6%,较其他三组高.而WBRT SRS组的晚期放射反应的发生率为12.2%,较其他组高.结论肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗,治疗失败后再行挽救性全脑照射或立体定向放疗.对于多发脑转移,全脑放疗加立体定向放射治疗(WBRT SRT)在提高生存率以及减少并发症方面优于其他治疗方法.

Efficacy of different radiotherapy methods in treatment of brain metastasis from lung cancer

Objective To analyze the prognostic factors and evaluate the efficacy of different radiotherapy methods in treatment of brain metastasis from lung cancer. Methods 176 patients with brain metastasis from lung cancer affirmed by pathology were divided into four groups: whole brain radiotherapy (WBRT) alone, stereotactic ra-diosurgery(SRS) combined with WBRT, stereotactic radiotherapy(SRT) combined with WBRT, stereotactic radio-therapy(SRT) alone.The patients of stereotactic radiosurgery(SRS) group received single tumor target dose ranging from 8 to 20 Gy in 1 to 3 fractions, with a total dose of 20 to 32 Gy.The patients of stereotactic radiotherapy (SRT) group received single tumor target dose ranging from 2 to 5 Gy in 5 to 30 fractions, with a total dose of 25 to 60 Gy. The dose of whole brain radiotherapy was 30 to 40 Gy in 18 to 25 fractions, with 1.8-2 Gy per fraction. Results The local tumor control rates of four groups were 47.0% , 87.7 % , 86.5 % and 78.0% ; the median survival time was 5.0,11.0,11. 5 and 10.0 months respectively; the median time of free from local progression(FFLP) was 3.33,8.33,9.33 and 7.67 months;the median time free from new brain metastasis(FFNBM) was 4. 11,8.57, 9.03 and 6.12 months.57% patients in WBRT died of brain metastasis and this fatality rate was higher than that in other 3 groups, with statistically significant difference( P < 0.05) .The late complication rate of stereotactic radi-osurgery( SRS) combined with WBRT group was 12.2%, with statistically significant difference as compared with other groups. Conclusion SRT alone is the optimal treatment for lung cancer with single brain metastasis, while saving WBRT or SRT is used after failure of SRT. For multiple brain metastases, SRT combined with WBRT not only improves survival time, but also reduces complication.