肺癌脑转移的放射治疗

目的　分析放射治疗肺癌转移的疗效及与化疗比较。材料与方法　 1980年 1月至 1996年 12月 ,对肺癌脑转移 12 6例进行回顾性研究。化疗采用CCNU ,BCNU ,CTX ,MTX ,DDP ,VP -16。放疗采用60 Co或 6MV X直线加速器 ,全脑DT30～ 40Gy ,并局部追加DT10～ 2 0Gy ,局部放疗DT35～ 5 5Gy。结果　全组 1、2年生存率分别为 16 7% (2 1/12 6 )、3 2 (4/12 6 ) ,中位生存时间为 7 9个月。单纯放疗组 1年生存率为 5 4% (3/86 ) ,中位生存时间为 7 0个月。放疗加化疗综合组 1、2年生存率分别为 2 5 7% (18/70 )、5 7% (4/70 ) ,中位生存时间为 8 6个月。结论　肺癌脑转移化疗加放疗综合治疗为主要治疗手段能提高疗效     

肺癌脑转移的三维适形放疗

目的通过观察分析适形放疗病例的结果,探讨三维适形放疗对肺癌脑转移的临床意义。方法共35例肺癌脑转移患者,其中合并颅外转移12例,非颅外转移23例。所有患者均首先经全脑放疗1.8~2Gy/次,5次/周,总量计DT30~40Gy。然后行适形放疗,90%的等剂量曲线包括靶区;分割剂量则根据靶区大小分为DT2~6Gy/次,5次/周,累计适形放疗剂量为20~40Gy。结果有效率(CR+PR)为85%(30/35)。治疗前脑部肿瘤直径<3cm患者肿瘤缩小要优于直径>3cm者。生存时间中位生存期10.3个月。结论三维适形放疗可以提高转移灶剂量,对于提高病灶的局控率明显有效,可以降低死于脑部病变复发比例。三维适形放疗在治疗脑转移的同时,颅外转移灶及原发灶的治疗也非常重要。     

榄香烯乳合并放疗治疗非小细胞肺癌脑转移临床研究

[目的]探讨中药榄香烯注射液合并放疗治疗非小细胞肺癌脑转移在提高疗效,改善生活质量方面的作用。[方法]将96例多发脑转移非小细胞肺癌患者随机分为试验组和对照组(各48例),试验组在全脑照射的同时用榄香烯乳注射液400mg/d～600mg/d,连续静脉点滴2周治疗,对照组单纯全脑照射。[结果]两组主要症状均有改善。对于瘤体的变化,试验组治疗后有效率(CR PR)为12.76%,对照组有效率(CR PR)为8.69%(P=0.178);试验组卡氏评分提高率为46.80%,而对照组为13.04%(P=0.0000)。[结论]榄香烯能够提高放疗的疗效,提高非小细胞肺癌脑转移患者的生活质量。     

分次立体定向放射治疗全脑放疗后肺癌脑转移瘤52例疗效分析

[目的]分析分次立体定向放射治疗全脑放疗后肺癌脑转移瘤的疗效及不良反应.[方法]2007年12月至2010年12月对KPS＞60分的52例全脑放疗后的肺癌脑转移(病灶数目少于4个)患者给予分次立体放射治疗,单次靶区周边剂量为3～5Gy,总剂量为15～25Gy,分3～5次完成,50％等剂量曲线包绕PTV.[结果]截至2011年12月,46例患者死亡.自再次放疗开始算起,全组中位生存期为10.7个月(95％CI为8.5～12.9),1年及2年生存率分别为28.4％和7.2％.全组临床症状缓解率为73.1％,肿瘤局部控制率为90.4％.仅1例患者出现放射性脑坏死.[结论]分次立体定向放射治疗用于全脑放疗后疾病进展的肺癌脑转移患者,可以提高生存质量、延长患者生存期,安全性较好,但需严格掌握适应证.     

多发脑转移瘤的放射治疗

多发脑转移瘤的放射治疗已经从上世纪80年代前的全脑放疗或最佳支持治疗逐渐发展到目前立体定向放疗广泛应用的时代。大量文献证实立体定向放疗联合全脑放疗较之单纯全脑放疗虽未提高患者的生存期,但可以改善多发脑转移瘤患者的颅内控制率,进而使患者的生活质量得到提高。近年随着人们对脑转移瘤患者认知功能的重视,有学者提出是否可以在脑转移瘤患者的首程治疗中省略全脑放疗。到目前为止共有4个随机分组研究对单纯立体定向放疗与立体定向放疗联合全脑放疗对患者认知功能以及生存的影响进行了较为深入的研究,其中3个已经有结果报道。目前的结论一致认为,省略全脑放疗后患者的颅内控制率显著降低,但挽救治疗后并未影响患者的总生存期,对这种治疗方式对脑转移瘤患者认知功能的影响其研究结果并不一致,还需积累更有说服力的数据。总之,目前多发脑转移瘤的治疗还缺乏统一的标准治疗模式,但对这部分患者的治疗越来越多的学者持有比较积极的态度。     

全脑照射加拓普替康治疗肺癌脑转移剂量 递增试验

 目的通过全脑照射加拓普替康每周化疗综合治疗肺癌脑转移,观察其不良反应、耐受剂量及临床 可行性。方法18例肺癌脑转移患者成为研究对象,全程常规分割照射,全脑剂量40Gy/20次,病灶较大者 局部加量至50～60Gy。拓普替康的用量从低剂量逐渐上升至高剂量,起始剂量为1.0 mg/m²,1次/周,4次 ,递增剂量为0.25 mg/m²,每剂量组至少3例,如无剂量限制毒性（DLT）出现则进入下一剂量组,直至出 现DLT,DLT的次一剂量即为最大耐受量（MTD）。结果DLT为3级放射性骨髓抑制,发生在拓普替康2.0 mg/m²剂量水平;则其次一剂量1.75 mg/m²即为MTD。主要不良反应为放射性骨髓抑制。结论全脑照射加拓 普替康每周化疗治疗肺癌脑转移具有临床可行性;拓普替康的最大耐受剂量为1.75 mg/m²。     

脑转移为首发症状的原发性支气管肺癌

本文分析了脑转移瘤为首发症状的原发性支气管肺癌３８例资料，着重对“脑先行”肺癌的二者关系进行探讨。结果表明：①腺癌最易发脑转移２０／３８，未分化癌脑转移最早。②外围型较中心型转移多见。③临床以精神异常及外伤就诊，一般呼吸道症状不明显。④ＣＴ对“脑先行”可起到先果后因的作用。并讨论肺癌脑转移的机制及诊治应取积极的态度。     

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。     

Radiotherapy for a Phalanx Bone Metastasis of a Lung Adenocarcinoma

Phalanx bone metastasis as the initial presenting sign of lung cancer is a rare presentation. Lung cancer is known to metastasize to the bone, but rarely to the fingers. A 61-year-old male smoker presented with pain in the left ring finger. Severe pain discouraged the patient from using his left hand. An X-ray of the left hand showed a lytic bone lesion. The patient was treated with finger radiotherapy. Analgesics were no longer needed and the patient was able to reuse his left hand in his everyday life. Palliative radiotherapy relieved our patient and improved his quality of life.Key words: Acrometastasis, Phalanx, Lung adenocarcinoma, Radiotherapy, Pain relief     

Clinical Observation of Whole Brain Radiotherapy Concomitant with Targeted Therapy for Brain Metastasis in Non-small Cell Lung Cancer Patients with Chemotherapy Failure

Objective: To investigate the clinical effects of whole brain radiotherapy concomitant with targeted therapyfor brain metastasis in non-small cell lung cancer (NSCLC) patients with chemotherapy failure. Materials andMethods: Of the 157 NSCLC patients with chemotherapy failure followed by brain metastasis admitted in ourhospital from January 2009 to August 2012, the combination group (65 cases) were treated with EGFR-TKIcombined with whole brain radiotherapy while the radiotherapy group (92 cases) were given whole brainradiotherapy only. Short-term effects were evaluated based on the increased MRI in brain 1 month after wholebrain radiotherapy. Intracranial hypertension responses, hematological toxicity reactions and clinical effectsof both groups were observed. Results: There were more adverse reactions in the combination group than inradiotherapy group, but no significant differences were observed between the two groups in response rate (RR)and disease control rate (DCR) (P>0.05). Medium progression free survival (PFS), medium overall survival(OS) and 1-year survival rate in combination group were 6.0 months, 10.6 months and 42.3%, while in theradiotherapy group they were 3.4 months, 7.7 months and 28.0%, respectively, which indicated that there weresignificant differences in PFS and OS between the two groups (P<0.05). Additionally, RPA grading of each factorin the combination group was a risk factor closely related with survival, with medium PFS in EGFR and KRASmutation patients being 8.2 months and 11.2 months, and OS being 3.6 months and 6.3 months, respectively.Conclusions: Whole brain radiotherapy concomitant with target therapy is favorable for adverse reactiontolerance and clinical effects, being superior in treating brain metastasis in NSCLC patients with chemotherapyfailure and thus deserves to be widely applied in the clinic.     

三维适形放疗配合全脑照射治疗脑转移瘤的疗效观察

目的：观察脑转移瘤患者采用三维适形放疗配合全脑放疗的近期疗效和毒副作用。方法：对33例脑转移瘤患者，先全脑放疗36Gy～40Gy（常规分割），然后针对转移灶行三维适形放疗20Gy～25Gy，2Gy～5Gy／次，5次／周或3次／周。结果：放疗结束后影像学疗效：完全缓解（CR）为45．5％，部分缓解（PR）为36．4％，无变化（NC）为15．1％，进展（PD）3％。放疗前有神经系统表现的32例患者放疗后神经系统症状完全缓解40．6％，部分缓解59．4％。所有患者的KPS评分均有不同程度的提高，截止随访期末死亡22例，中位生存期为9．3个月。结论：三维适形放疗配合全脑照射脑转移瘤能有效地控制脑转移病灶，改善生活质量，并有延长生存期的趋势，疗效优于常规治疗。     

多西紫杉醇和顺铂联合全脑放疗治疗非小细胞肺癌脑转移的疗效

目的探讨多西紫杉醇和顺铂联合全脑放疗,治疗非小细胞肺癌脑转移的近期疗效及患者生存期和生存质量。方法将40例非小细胞肺癌脑转移患者随机分为A组和B组,各20例。A组,采用＂多西紫杉醇＋卡铂＂方案：多西紫杉醇75 mg/m2,d1;顺铂40 mg/m2,d1～2。B组,采用＂替尼泊甙＋顺铂＂方案：替尼泊甙60 mg/m2,d1～5;顺铂40 mg/m2,d1～2。每21天为1个周期。脑部放疗：6MV-X线直线加速器,脑部病灶≤3个,全脑放疗40 Gy/20次后,根据情况缩野加量14～16 Gy/7～8次;脑部病灶〉3个,全脑放疗至40 Gy/20次。全脑放疗至20～30 Gy/10～15次时同时行化疗。结果对脑转移的控制有效率（CR＋PR）A组为70.0%（14/20）,B组为65.0%（13/20）,两组比较无显著性差异（P〉0.05）;中位生存期两组分别为14和9个月;中位肿瘤进展时间（mTTP）分别为9.7和6.3个月,两组比较有显著性差异（P〈0.05）;1年生存率两组分别为65.0%（13/20）和30.0%（6/20）,两者比较有显著性差异（P〈0.05）。两组治疗前后KPS评分比较,差异有统计学意义。结论多西紫杉醇和顺铂联合全脑放疗对非小细胞肺癌脑转移控制率无明显提高,但延长了患者生存期及肿瘤进展时间（TTP）,具有较好疗效。     

Thymic Carcinoma with Brain Metastasis Mimicking Meningioma

Thymic carcinoma is a rare malignancy, which differs from thymoma in that it displays histopathologically malignant features, extensive local invasion, and a substantial potential for metastasis, predominantly to the liver and kidney and rarely to the central nervous system. Most of cerebral metastases are the intraaxial tumor, whereas extraaxial masses mimicking meningioma are extremely rare. A 32-year-old woman who had been treated for thymic carcinoma with multiple bone metastasis including spine and ribs was referred to the neurosurgery department with a diagnosis of right temporal extraaxial mass. Magnetic resonance imaging (MRI) revealed an extraaxial tumor with hemorrhage along the medial margin of tumor. A craniotomy was performed to remove the mass that was located extraaxially. Histopathological and immunohistochemical examination revealed undifferentiated thymic carcinoma with neuroendocrine differentiation. The patient recovered from the preoperative deficits, and local irradiation of 50Gy was performed. This paper will examine briefly the radiolographic and pathologic characteristics of this unusual lesion. Although extraaxial thymic carcinomas are rare, they should be considered in the radiographic differential diagnosis of dural-based lesions, especially for patients with history of thymic lesions.     

Intracranial Metastasis in a Patient with Hepatocellular Carcinoma and Gastric Cancer

A 76-year-old man was referred to our hospital with visual disturbance, weakness of the left upper and lower limbs, and gait disturbance. He had previously received transarterial chemoembolization for hepatocellular carcinoma (HCC) 3 and 10 years ago. When he had received radiofrequency ablation for HCC recurrence 2 years ago, total gastrectomy was also performed for his gastric cancer. Subsequently, sorafenib had been administrated for concomitant lung metastatic tumors. On admission, MRI revealed an intra-axial tumor with perifocal edema. The level of carcinoembryonic antigen, but not alpha-fetoprotein, markedly increased. The tumor was successfully removed by craniotomy and pathological examination revealed that it was composed of adenocarcinoma, which was consistent with the primary gastric cancer. After surgery, his neurological disturbances rapidly resolved. Additional gamma-knife treatment was also performed for another small brain metastasis detected after craniotomy. Subsequently, sorafenib administration was discontinued and S-1 was administered postoperatively. Successful treatment of intracranial metastasis of gastric cancer is important and meaningful, even in patients with multiple primary malignancies.Key words: Multiple primary malignancy, Hepatocellular carcinoma, Gastric cancer, Double cancer, Intracranial metastasis, Surgical resection     

肺癌脑转移的治疗进展

肺癌脑转移的发生率高达25．4％～65％，占脑转移瘤的40％～60％，如果不治疗，平均生存期1～2个月。全脑放疗是传统有效的治疗手段，可提高中位生存时间4～5个月。立体定向放射治疗对〈4cm的转移灶疗效与手术相当。可使中位生存期达到9～15个月。而手术治疗在单发转移、肿瘤较大有明显占位效应致颅内压升高的患者可以获益。目前立体定向放射治疗和／或手术治疗＋／-全脑放疗＋／-化疗是肺癌脑转移的治疗模式，而分子靶向药物的治疗尚在探索之中。     

全脑联合三维适形放射治疗30例单病灶脑转移癌的疗效分析

背景与目的:全脑放疗是治疗脑转移癌的主要治疗手段。本文总结全脑联合三维适形放射治疗单病灶脑转移癌的疗效。方法:30例恶性肿瘤单病灶脑转移癌,全脑放疗DT39～45Gy后,以三维适形放疗追加转移病灶DT10～16Gy,常规分割1次/d,5次/w,总剂量DT55Gy。结果:6例CR,21例PR,3例NC,6个月、1年和2年生存率分别为73.3%(22/30)、40%(12/30)、13.3%(4/30),平均生存时间11.9个月。结论:全脑联合三维适形放射治疗单病灶脑转移癌,可以缓解颅脑神经症状,改善生活质量,延长生存期。