放射治疗联合替莫唑胺治疗脑转移瘤的疗效分析

目的:观察放射治疗联合替莫唑胺治疗脑转移瘤患者的疗效。方法:将62名脑转移瘤患者随机分为放疗组和放疗联合替莫唑胺组。其中放疗组给予全脑照射,采用6MV－X线常规照射,2Gy/次,5次/周,共4周,总量40Gy,全脑放疗后,只对最大的2个病灶缩野加量至50-56Gy。放疗联合替莫唑胺组中,放射治疗方法同放疗组,并在放疗的整个疗程中同步口服替莫唑胺75mg/m2化疗至放疗结束。放疗结束后4周,继续使用替莫唑胺化疗,其中第1周期给量150mg/m2,连续用药5天,28天为一个疗程,若患者耐受良好,在以后化疗疗程中增量至200mg/m2,替莫唑胺推荐化疗6个周期。结果:放疗联合替莫唑胺组的有效率为83.9%,高于放疗组的71.0%（P>0.05）。中位生存期和1年生存率分别为14个月和58.1%,均高于放疗组的10个月和32.3%（P<0.05）。放疗联合替莫唑胺组的疾病控制率为93.6%,优于放疗组的90.3%。两组患者均未出现严重的不良反应。结论:替莫唑胺联合放疗在脑转移瘤的治疗中有较好的疗效和安全性。     

Radiotherapy for metastatic bone tumor

There is good evidence that radiotherapy is effective in relieving bone pain due to metastatic tumor. For localized bone pain, external beam treatment will be successful in reducing pain in some 80% of patients. Many prospected randomized trials show single fractions as effective as more prolonged regimens both in terms of incidence and duration of pain relief. For scattered painful metastases, wide-field hemibody irradiation or the systemic administration of radioisotopes is effective.     

Radiotherapy for metastatic brain tumors

Radiation therapy has been the most important treatment for patients with brain metastases. With the development of stereotactic irradiation, conventional radiotherapy is being employed less often. However, whole-brain radiation therapy (WBRT) is still the mainstay of treatment for multiple brain metastases. This article reviews the results of conventional radiotherapy for brain metastases, and discusses optimal treatment, including fractionation schedules and combination with stereotactic irradiation, and the effects on neurocognitive functions. The authors conclude that WBRT with 30 Gy in ten fractions is no longer optimal for every patient with multiple brain metastases. WBRT employing appropriate fractionation schedules with or without stereotactic boost should be considered, depending on the patient’s condition, disease status, and expected period of life.     

Radiotherapy of metastatic brain tumors

In order to evaluate the role of radiotherapy cases of brain metastases, we retrospectively have analyzed the results of treatment in 89 patients with brain metastases, who had completed a course radiotherapy at the Jichi Medical School Hospital from August, 1973 to October, 1986. Cases analyzed included 60 patients with lung cancers, 6 with breast cancers, 6 with gastric cancers, 10 with other types, and 7 with unknown primary sites. The over-all median survival time was 4.7 months. Crude survival rates were 38.2% at 6 months, and 11.2% at one year, respectively. Two patients survived more than 3 years. The over-all rate of improvement of neurologic function (NF) were 75.3% of NF III patients, and 58% of NF II patients. There was, however, no significant difference in survival rates between the patients with and without NF improvement. Prognostic factors were investigated by a statistical method of a proportional hazard model. Age, the combined treatment with surgery and irradiation, and the neurologic standard dose (Neuret) were found to be factors which influenced the survival rate with a fair statistical significance. Survival rate increased with a decrease in age, an increase in the thoroughness of the surgical excision, and an increase in the Neuret dose. These data suggest that an aggressive approach to brain metastases in younger patients, so far as clinical judgements permit, may indeed improve survival.     

放射治疗脑转移瘤患者生存分析

目的 探讨放射治疗脑转移瘤患者的年龄、原发肿瘤部位、转移灶数量、合并症等因素对生存时间的影响,指导个体化临床治疗.方法 回顾分析和对比资料完整的107例住院放疗脑转移瘤患者的临床各相关因素及患者生存时间.结果 P＞60岁组生存期短于≤60岁组(P＜0.05);有颅外未控病灶患者生存期短于无颅外未控病灶者(P＜0.01);合并糖尿病、脑血管病患者生存期短于无合并症者(P＜0.05);不同原发肿瘤各组间生存时间差异有显著性(P＜0.01);转移瘤数量1～3个者较3个者以上生存期延长(P＜0.01);不同性别患者生存期差异无显著性(P＞0.05).结论 老年,颅外病灶未控,合并糖尿病、脑血管病及转移瘤＞3个是脑转移瘤患者的预后不良因素.     

恶性滋养细胞肿瘤脑转移的放射治疗

From 1982 to 1985, 26 patients with malignant trophoblastic tumor were treated. Of them, 8 patients developed brain metastasis. Seven out of these 8 patients were treated with 60Co whole brain radiotherapy. The total dose on the longitudinal mid-plane of brain was 3300 cGy/2-3 weeks. Four patients were cured, 3 of them have survived without recurrence or sequelae for 6.5, 6 and 4.5 years, respectively; the other one died of liver metastasis 1 year after radiotherapy. Radiotherapy is an effective method in the combined treatment for brain metastasis of malignant trophoblastic tumors.     

放射治疗脑转移瘤130例临床分析

目的:探讨脑转移瘤病人的预后因素及不同治疗方法对其的影响。材料和方法:本文对1977.5至1996.5收治的脑转移瘤130例病人进行回顾性分析。原发肿瘤为肺癌的118例,其它来源的为12例。所有病人给予全脑放疗,其中,辅以手术的17例;辅以化疗的63例。结果:中位生存期为10个月。1年生存率为32％。年龄≤65岁、单发转移灶、无其它部位转移者预后好;原发乳腺癌的脑转移瘤病人比原发肺鳞癌及小细胞肺癌的预后好。放疗剂量≥60Gy组与<60Gy组比较,有效率由33％提高至100％(这P<0.01),但其晚期损伤发生率也由0提高至75％(P<0.05)。结论:放疗对脑转移瘤有很好的姑息效果,但通过增加放疗剂量而提高疗效有一定困难,对部分病人,尤其是首程放疗复发者,采用手术,X—刀式7—刀加全脑放疗方法治疗脑转移瘤不失为一种十分有效的方法。     

Early diagnosis of metastatic brain tumor

For the early diagnosis of metastatic brain tumor, careful and long-term follow-up is important when the primary tumor has already been found. Metastatic brain tumor should be suspected whenever neurological symptoms develop in such a patient. In the cases of lung cancer or lung metastases, CT scan of brain should be taken even if the patients have no neurological symptoms, because lung cancer frequently metastasizes to the brain and other cancers metastasize to the brain via the lung. When the primary sites are unknown, primary brain tumors should be distinguished. Relatively rapid progression of symptoms including mental disturbance, multiple lesions on CT scan, lesions on chest X ray film, careful cerebral angiogram and MRI are helpful for the differential diagnosis.     

Radiotherapy of metastatic bone tumor with a synthetic calcitonin derivative (Elcatonin) with irradiation

Twenty cases of metastatic bone tumors were treated with Elcatonin together with irradiation, achieving pain relief in 47.3% of cases, improved bone scintigrams in 16.7% of cases and radiographic improvement of invaded bone in 7.7% of cases. It has reported that calcitonin is effective for pain relief in 50% of cases but for the radiographic improvement of bone lesions in only 0-10%. The life quality of patients with bone metastases is controversial since treatment techniques for advanced oncological patients has progressed remarkably. The pain relief obtained with calcitonin contributes significantly to improving the quality of life for such patients when administered in combination with conventional treatment modes.     

Surgery for metastatic brain and spinal tumor from colorectal cancer

The results of invasive treatment of brain metastasis of colorectal cancer (6 cases) and spinal metastasis of colorectal cancer (3 cases), aimed at alleviating the symptoms, were analyzed. In all 6 cases of brain metastasis, metastases were also found in some other remote sites (often the liver). The average period from resection of the primary lesion to resection of the brain metastasis was 3 years and 3 months for this group. Of these 6 cases, 5 had cerebral metastasis and 1 had cerebellar metastasis. The preoperative performance status (PS) was 1 in 1 case and 2 in 5 cases. After surgery, the PS improved in all 6 cases, allowing all the patients to be discharged. There was only one patient whose death was attributable to brain metastasis. In all 3 cases of spinal metastasis, metastases were also detected in the lungs or liver (synchronous in) 1 case, metachronous in 2 cases). The preoperative PS was 2 in 1 case, 3 in 1 case and 4 in 1 case. After surgery, the PS improved in 2 cases. One of the three patients is still alive. CONCLUSION: The results of this study suggest that it is not impossible to improve the QOL of patients with brain or spinal metastasis of cancer by surgical intervention, although the response may vary from patient to patient.     

Management of metastatic melanoma patients with brain metastases

Brain metastases seem to be an almost inevitable complication in patients with metastatic melanoma. Except for the rare patients who can undergo successful surgical resection of brain metastases, current management strategies do not appear adequate and result in a poor outcome (median survival, 2–4 months). In recent small series, stereotactic radiosurgery or gamma-knife treatment has suggested improvement in local control compared with whole brain radiation therapy. We have recently shown prolonged survival (11.1 months) using a multimodality treatment approach in 44 sequential patients with melanoma brain metastases. A subsequent study demonstrated that the outcome of biochemotherapy for metastatic melanoma is not affected by the presence or absence of brain metastases. Our results suggest that the outcome of patients with melanoma brain metastases can be improved using a multidisciplinary management strategy.     

Radiotherapy for brain tumors

Over the last 2 years, several advances have been made in the field of radiotherapy for brain tumors. Key advances are summarized in this review. Crucial technologic advances, such as radiosurgery, fractionated stereotactic radiotherapy, and intensity-modulated radiotherapy, are discussed. Better understanding of the interaction between the processes of angiogenesis, apoptosis, cell-cycle regulation, and signal transduction and the effects of ionizing radiation has made it clear that many of these ‘new agents’ are, in fact, valuable modulators of the radiation response. Another exciting molecular discovery is the recognition of radiation-induced promoters that can be exploited to cause spatially and temporally configured expression of selected genes; this approach may represent the ideal application of conformal radiation techniques in the future, yielding welldefined genetic changes in specifically targeted tissues. The final ‘frontier’ covered in this review is the newer categories of radiosensitizers, ranging from topoisomerase-I inhibitors, to expanded metalloporphyrins, to oxygendissociating agents.     

Home rehabilitation for brain tumor patients

To determine whether a program of post-discharge rehabilitation at home for patients operated for brain tumor was associated with functional gain and improvement in Quality of Life (QoL). One hundred and twenty-one patients affected by malignant brain tumor were enrolled in a program of post-discharge home care including neurorehabilitation. Functional outcome was evaluated with Barthel Index (BI) and Karnofsky Performance Status (KPS) measured before and after rehabilitation. The impact of rehabilitation on quality of life was evaluated with a quality of life questionnaire (EORTC QLQ-C30-BM 20). Results: Barthel Index improved in 47 (39%) patients, was stable in 20 (16%) and worsened in 54 (44%). Only 54 patients completed the QoL questionnaire before and after treatment. After three months of rehabilitation, 72% of patients were found to have an improvement in at least one domain score compared with their baseline QoL scores. Rehabilitation at home in brain tumor patients was associated with significant functional gain measured both with BI and KPS. The benefit of rehabilitation may influence patient's perception of quality of life.     

Radiation treatment of metastatic tumor in the brain

Sixty-seven patients with metastatic tumor in the brain were seen from 1975 to Oct. 1985. 11 of the 22 untreated patients were followed to their death, the median survival was 2.9 months. The other 45 patients were all treated by irradiation. 40(89%) patients had bronchogenic carcinoma, three had primaries in other parts of the body and two had unknown primaries. In 16 patients, whole brain was irradiated to a dose of 1000-4000 cGy. Their 6 month survival rate was 25% but all died within one year. In 24 patients, whole brain was first irradiated to 3000-4000 cGy. Then the dose was increased to 5000-6000 cGy by cone down technique. Their 6 month survival was 75%, 1 year survival 33%. The high-dose-cone down method is obviously more effective. In the other 5 patients who were retreated locally for recurrence or new foci in the other parts of the brain, their survival was 4 to 8 months taken from the start of the second course of radiotherapy. One of these five patients is still living as of this writing. Extensive brain necrosis was observed in three patients who received whole brain radiation in the second course. Yet untoward reactions were noted in the two patients who received local irradiation in the second course. This may imply that, for the second course, only local radiation is indicated.     

射波刀治疗脑转移瘤的疗效观察

目的评价射波刀治疗脑转移瘤的近期疗效。方法回顾性分析经射波刀治疗的46例脑转移瘤患者的临床资料,评价治疗后的近期疗效,并测量治疗前和治疗后行MRI扩散加权成像扫描的表观扩散系数(ADC)值。结果 46例脑转移瘤患者径智能射波刀治疗后,治疗好转率和有效率分别为82.6%和95.7%,6个月和1年的生存率分别为82.6%和52.2%,中位生存时间为13个月。行MRI检查的31例患者(45处病灶)治疗后ADC值均较治疗前有不同程度增高。结论射波刀治疗脑转移瘤的临床疗效较好,值得临床进一步推广。     

脑转移瘤的预后分析

目的 回顾性分析脑转移瘤的预后因素，探讨RTOG脑转移瘤回归分割分析（RPA）分类的适应性。方法 对371例脑转移瘤进行了回顾性分析，主要分析因素有年龄、病理、原发灶控制、KPS评分、Hb值、中枢外转移、治疗方法，分别进行单因素分析和多因素分析。对全组病例根据RTOG标准进行分类，对不同生存情况进行比较。结果 全组中位生存期8．0个月，1、2、3年生存率分别为37．8％、18．4％、12．2％。Cox模型多因素分析显示KPS评分、原发灶控制、治疗方法、转移灶是否为单发为独立预后因素。RPA分类I、Ⅱ、Ⅲ类中位生存期分别为22．0、9．0、5．0个月，3类患者生存期有明显差异。结论 脑转移瘤预后因素主要为KPS评分、原发灶是否控制、颅内转移是否为单发。积极治疗可适当延长患者生存期，RTOG脑转移瘤的RPA分类有较好适应性。