大分割立体定向放射治疗对非小细胞肺癌脑转移瘤的疗效评估

目的探讨伽玛射线大分割立体定向放疗(SRT)加或不加全脑放疗(WBRT)对肺癌有限脑转移瘤治疗的疗效。方法回顾性分析非小细胞肺癌多发脑转移瘤(1~4枚)患者66例,其中单纯SRT 30例,SRT+WBRT 36例。分析两组患者的临床特征并应用Kaplan-Meier法计算生存率,用Logrank法对各因素进行预后分析。结果两组患者的临床特点无明显区别;SRT组与WBRT+SRT组的中位生存期(MST)分别为12.1与13.3个月,两者无显著性差异(P=0.216)。Logrank分析显示卡氏评分(P=0.017)和颅外病变的控制情况(P=0.032)是影响预后的主要因素。结论SRT是非小细胞肺癌有限脑转移瘤患者有效治疗手段,单纯SRT可取得与WBRT加SRT相似的生存期。     

旋转式头部伽玛刀治疗脑转移瘤171例临床分析

目的 探讨旋转式头部伽玛刀在脑转移瘤治疗中的作用及疗效.方法 2010年9月至2011年10月间,我院共有171例脑转移患者接受了放射治疗,其中49人接受单纯全脑放疗（WBRT组）,占28.7％;102例接受了伽玛刀治疗,其中单独伽玛刀治疗（SRS组）50例,占29.2％;伽玛刀联合全脑放疗（WBRT＋ SRS组）72例,占42.1％.WBRT组患者接受全脑放疗40 Gy/20f/4w; SRS组患者接受旋转式头部伽玛刀治疗16 ～ 24 Gy/1f;WBRT＋ SRS组患者接受全脑放疗30 Gy/15f/3 w,后加旋转式头部伽玛刀治疗12 ～16 Gy/1f.观察3组患者的临床效果和并发症,并进行统计处理,分析三组患者的1年局部控制率和1年生存率.结果 3组患者均取得良好效果,未出现严重毒副作用;1年局部控制率分别为52.8％、81.7％、88.1％;1年生存率分别为47.6％、87.8％、92.9％.SRS组、WBRT＋ SRS组1年局部控制率和1年生存率明显高于WBRT组（P＜0.005）,差异有统计学意义;而SRS组和WBRT＋ SRS组1年局部控制率及1年生存率差异无统计学意义（P＞0.10）.结论 单纯头部伽玛刀治疗以及头部伽玛刀联合全脑放疗治疗脑转移瘤,安全有效,较传统的外照射全脑放疗,可以提高患者的生存时间及生存质量.     

伽玛刀治疗肺癌脑转移瘤的疗效及影响生存时间和预后的相关因素分析

目的探讨伽玛刀治疗肺癌脑转移瘤方面的疗效及分析与其生存时间和预后相关的因素。方法选取106例于2013年1月至2015年1月期间在本院行伽玛刀治疗的肺癌脑转移瘤患者,按照其手术方式进行分组,其中42例行立体定向放射外科(SRS)治疗,30例行立体定向放射治疗(SRT)治疗,17例行SRS联合全脑放疗(WBRT)治疗,13例行SRS/SRT挽救治疗,4例行SRS联合WBRT挽救治疗,观察患者的疗效并分析影响其生存时间和预后的相关因素。结果 106例肺癌脑转移瘤患者经伽玛刀治疗后6个月生存率为50%,各种治疗方法治疗后的生存率和中位生存期分别为61%、57%、42%、30%、2%和9、8、6、5、3个月,差异有统计学意义(P0.001);多因素Logistic回归分析的结果显示影响经伽玛刀治疗的肺癌脑转移瘤患者预后的相关因素主要有KPS评分、原发灶的控制情况、病理分型以及是否进行过前期颅内治疗(P0.05)。结论肺癌脑转移瘤使用伽玛刀治疗可获得相似的生存率;影响患者术后生存时间和预后的因素主要是KPS评分、原发灶的控制情况、病理分型以及是否进行过前期颅内治疗。     

X刀治疗多发脑转移瘤的临床研究

目的探讨X-刀治疗多发脑转移瘤的预后因素及X-刀在多发脑转移瘤治疗中的作用.方法在4种预后因素(年龄、治疗前KPS评分、有无远处转移、颅外病灶控制情况)相同或相似的条件下,配对选择两组病例.X-刀加全脑放疗组和常规放疗组各53例.常规放疗组采用全脑照射30～40Gy/3～4周.在X-刀加全脑放疗组中,X-刀治疗采用单次照射40例,分次照射13例,单次靶区平均周边剂量为20Gy.分次照射方法为4～12Gy/次,2次/周,总剂量为15～30Gy.结果KPS评分,颅外肿瘤病变稳定,以及颅内转移灶的数目是影响多发脑转移瘤病人预后的重要因素.中位生存期均有明显差异.在死因分析中,X-刀加全脑放疗组死于脑转移的比例为27%,比常规放疗组的51%低(P＜0.05).但两组病例的放射并发症的发生率相似.结论对于多发脑转移瘤,X-刀加全脑放疗在提高局部控制率,延长生存期和提高生存质量方面均优于单纯放射治疗.     

全脑放疗联合旋转式伽马刀治疗肺癌脑转移瘤的疗效

目的：观察全脑放疗联合旋转式伽马刀治疗肺癌脑转移瘤的临床疗效。方法选取2008-03-2013-03我院肺癌脑转移瘤患者128例,按治疗方式分为单纯全脑放疗组和联合治疗组各64例,分别给予单纯全脑放疗和全脑放疗联合旋转式伽马刀治疗,对比2组临床疗效。结果联合治疗组有效率89·06％,明显高于对照组的46·88％,P＜0·05。结论全脑放疗联合旋转式伽马刀治疗肺癌脑转移瘤患者疗效较好,且更安全。     

肺癌脑转移214例生存及预后分析

目的 探讨各种因素对214例肺癌脑转移病例生存的影响,分析可能影响预后的因素.方法 对1992年1月至2001年12月浙江省肿瘤医院收治的214例肺癌脑转移病例资料进行回顾性分析.共有35例(16.4%)颅内单发转移瘤接受手术切除,其中单纯手术10例,手术联合全脑放疗8例,手术联合化疗2例,手术联合全脑放疗和化疗15例,单纯全脑放疗10例,单纯化疗36例,全脑放疗联合化疗104例,支持治疗29例.生存期定义为从患者接受治疗开始至死亡或随访结束的时间.应用Kaplan-Meier方法 计算1、3、5年生存率和中位生存期并描绘生存曲线,long-rank试验评价组间生存差异,Cox回归多因素分析影响肺癌脑转移预后的各种因子.结果 214例肺癌脑转移病例的中位生存期为10个月(95%C/9.06～10.94),1、3、5年累积生存率分别为7.46%、1.14%和0.根据患者的年龄、性别、病理类型和原发肿瘤分期及颅外脏器转移数目分析患者生存率,显示各组生存差异无统计学意义.各治疗方式中位生存期以联合手术、放化疗的综合治疗方式生存期最长(17个月),而手术联合化疗组和支持治疗组分别为3个月和4个月(P=0.00).Cox回归多因素分析表明治疗方式是惟一的独立预后因素.结论 对肺癌脑转移病例的积极治疗是有益的,其中联合手术治疗和全脑放疗、化疗等手段的综合治疗是最有效的.患者的年龄、性别、TNM分期和病理类型等因素和预后无明显相关.     

吉非替尼对非小细胞肺癌脑转移的预后分析

目的：探讨吉非替尼对EG FR突变（＋）非小细胞肺癌脑转移预后的影响。方法回顾性分析我院收治的70例EGFR突变（＋）非小细胞肺癌脑转移患者的临床资料,根据治疗方法不同分为治疗组和对照组各35例,其中对照组给予常规全脑放疗,治疗组在对照组的基础上给予吉非替尼治疗,比较2组临床效果和不良反应发生情况。结果治疗后治疗组有效率48.57％,显著高于对照组的34.28％（ P＜0.05）;治疗组疾病控制率77.14％,显著高于对照组的60.00％（ P＜0.05）;治疗组C R率17.14％,显著高于对照组的8.57％,治疗组PD率22.86％,显著低于对照组的40.00％（ P＜0.05）;治疗组不良反应发生率45.71％,对照组42.86％,2组比较无显著差异（ P＞0.05）。结论吉非替尼联合全脑放疗治疗 EG FR突变（＋）非小细胞肺癌脑转移患者不良反应小,临床效果显著。     

立体定向放射外科治疗脑转移瘤

目的：探讨脑转移瘤的立体定向放射治疗的方法,临床结果。方法：采用单纯ＳＲＳ治疗颅内转移瘤３３例,ＳＲＳ＋ＷＢＲＴ治疗４２例,３１例行单纯全脑放疗。单纯ＳＲＳ治疗的剂量为１４～２２Ｇｙ／单次,ＳＲＳ＋ＷＢＲＴ则在单次ＳＲＳ后在行全脑放疗３０～４０（ｙ）３～４周,单纯ＷＢＲＴ治疗剂量４０～５０Ｇｙ／４～５周。结果：经２～３年随访,ＳＲＳ组３３例ＰＲ＋ＣＲ局部控制率８７．８％,一年生存率７５．８％,两年生存率４５．５％;ＳＲＳ＋ＷＢＲＴ组４１例,ＣＲ＋ＰＲ９２．９％,一年生存率８８．１％,两年生存率４７．６％;两组对照无显著差异（Ｐ〉０．１０）,但无对照有显著差异（Ｐ〈０．０５）,ＷＢＲＴ组３１例,ＣＲ＋ＰＲ８７．１％,两年生存率２５．８％,与ＳＲＳ＋ＷＢＲＴ组对照无显著差异（Ｐ〉０．１０）,瘤生存率分别为４８．４％     

脑转移瘤52例临床分析

目的 探讨脑转移瘤的发病率、来源、诊断、治疗与预后。方法 对52例脑转移瘤进行手术切除、减压加放疗的综合治疗。结果 完全缓解35例,部分缓解7例,无变化5例,进展5例,无围手术期死亡病例,平均生存期15个月。结论脑转移瘤有较高的发病率,原发肿瘤以肺癌最常见,占71.79％,对原发肿瘤较小、无其他部位转移、预测能生存较长时间的患者,应争取行手术切除脑转移灶,术后加放射治疗等综合治疗,对延长生存期,改善生活质量具有重要意义。     

三维适形放疗联合替莫唑胺化疗对术后脑胶质瘤的疗效观察

目的分析比较三维适形放疗联合替莫唑胺化疗和单纯放疗对脑胶质瘤部分切除术后患者的疗效和安全性。方法选取自2003年10月至2006年6月42例脑胶质瘤部分切除术后患者，随机分为2组：单纯放疗组（19例）仅行三维适形放疗，分次局部照射，2．0Gy／次，1次／d，5d／周，共持续6周，总剂量60Gy；联合治疗组（23例）于三维适形放疗同时联合替莫唑胺化疗6周＋辅助化疗6疗程。影像学动态观察患者肿瘤体积的变化及Karnofsky评分评价神经功能状态。结果放疗结束24周后，联合治疗组在影像学所示肿瘤实体的缩小和神经功能状态（日常生活能力）的改善方面均优于单纯放疗组（P〈0．05）。结论放疗联合替莫唑胺化疗可提高脑胶质瘤部分切除术后肿瘤缓解率和患者生活质量。     

Brain metastases from unknown primary tumour

The best management of patients with brain metastases from an unknown primary tumour is still unclear, as data are scarce and studies are retrospective. We report 33 patients with biopsy-proven brain metastases from a primary tumour not found at the first investigations, who were treated by surgery and/or radiotherapy and followed with serial CT until death. Median survival time for all patients was 10 months and survival rates at 6 months, 1 year and 2 years were 76 %, 42 % and 15 % respectively. Patients with single brain metastasis treated by gross total resection and whole-brain radiotherapy (WBRT) had a median survival of 13 months with 76 % alive at 6 months, 57 % at 1 year and 19 % at 2 years. Patients with multiple brain metastases who underwent either WBRT alone or WBRT preceded by gross total resection of the symptomatic lesions had a poorer prognosis: median survival of 6–8 months with 50–100 % alive at 6 months, 17–20 % at 1 year and none alive at 2 years. In 85 % of patients with a single brain metastasis a significant improvement in neurological functions was observed after surgical resection; among patients with multiple brain metastases a neurological improvement was observed in all patients who had a resection of symptomatic lesions and only in a half of patients who had WBRT alone. During the follow-up the primary tumour was found in 27/33 patients (82 %) and was located in the lung in 78 %. Between 1987 and 1991 (with limited screening for the primary tumour in the follow-up) the unknown tumours were 6/15 (40 %); in the more recent period (1992–1996) (CT-based screening for the primary tumour in the follow-up) no primary tumour remained unknown but overall survival has not significantly improved. The number of brain metastases was the only significant factor affecting survival after both univariate and multivariate analysis. This study suggests that, in patients with both single and multiple brain metastases from an undetected primary site when first studied, surgery and/or WBRT enable the control of the brain disease, partly because the systemic disease may be silent for a prolonged time. Only a few asymptomatic patients may benefit from an early detection and treatment of the primary tumour during the follow-up. Received: 1 May 2000 / Received in revised form: 13 October 2000 / Accepted: 10 December 2000     

非小细胞肺癌同步脑转移的治疗(附19例临床分析)

目的 探讨积极处理原发灶能否使非小细胞肺癌(NSCLC)同步脑转移患者受益,以寻找合理治疗方案.方法 回顾性分析中山大学肿瘤防治中心神经外科自2000年1月至2009年1月收治的19例NSCLC同步脑转移患者的临床资料,分析其治疗及生存情况.结果 患者中位生存时间为14.5个月,1年生存率为52.6％,2年生存率为17.5％.肺原发灶的处理不同,患者生存率不同,差异有统计学意义(x2=10.532,P=0.005),其中脑转移瘤术后行肺叶切除+化疗组、化疗组和姑息治疗组患者生存率依次降低,差异有统计学意义(P＜0.05);单发脑转移瘤患者生存率高于多发脑转移瘤患者,差异有统计学意义(x2=3.882,P=.049).结论 NSCLC同步脑转移,尤其是单发脑转移患者,在处理转移灶的同时,积极处理原发肿瘤可延长患者生存时间.     

脑转移瘤患者单纯手术治疗与手术联合术后脑部放疗对比分析

目的 总结脑转移瘤单纯手术和手术联合术后脑部放疗的治疗经验,并筛查此类患者放疗获益的相关影响因素.方法 纳入北京协和医院脑转移瘤数据库中2011年1月1日至2018年12月31日的成人脑转移瘤患者141例,根据不同治疗方案分为单纯手术组(91例)和手术联合术后脑部放疗组(联合治疗组,50例),收集性别、年龄、脑转移瘤数...     

Gamma knife radiosurgery for multiple brain metastases from lung cancer

The aim of this study was to compare the effectiveness of gamma knife radiosurgery (GKS) for the treatment of multiple brain metastases from lung cancer with that of whole brain radiation therapy (WBRT). Patients with multiple (2-20) brain metastases were divided into two groups for initial brain tumor management: a GKS group (14 patients) and a WBRT group (19 patients). The patients were stratified by gender, age, initial Karnofsky performance status score, control of the primary site, known extracranial metastases, number of brain metastases, diameter of the maximal lesion, chemotherapy, and recursive partitioning analysis (RPA) Class. The 6-month and 1-year overall survival rates were 64.3% and 47.7%, respectively, in the GKS group, and 42.1% and 10.5%, respectively, in the WBRT group. The median survival time was 32 weeks in the GKS group and 24 weeks in the WBRT group. The overall survival time in the GKS group was significantly longer than in the WBRT group (p = 0.04). The univariate analysis suggests that survival was increased in both patients with a controlled primary tumor site and in the GKS group (p = 0.03, 0.04). The use of GKS in patients with multiple brain metastases significantly improved patient survival compared to the employment of WBRT. When we assessed the subgroups, systemic disease control and GKS were significant variables by univariate analysis.     

三维适形放疗联合替莫唑胺治疗恶性脑胶质瘤术后患者的Meta分析

目的系统评价三维适形放疗联合替莫唑胺（3D-CRT/TMZ）治疗恶性脑胶质瘤术后患者的疗效及安全性。方法检索EMbase、PubMed、Cochrane、中国知网、维普数据库和中国生物医学文献服务数据库等数据库,查找3D-CRT／TMZ治疗恶性脑胶质瘤术后患者的临床随机对照试验,采用RevMan5．2．0软件进行Meta分析。结果共纳入16个研究,共1410例患者。Meta分析结果显示：与3D-CRT相比,3D-CRT／TMZ能显著提高恶性脑胶质瘤术后患者治疗的有效率[优势比（OR）=3．60,95％可信区间（CI）为2．35-5．50,P〈0．00001]、术后1年生存率（OR=3．51,95％CI为2．53～4．87,P〈0．01）、术后2年生存率（OR=3．67,95％CI为（2．61～5．16,P〈0．01）和术后3年生存率（OR=3．73,95％CI为2．44～5．71,P〈0．01）及显著延长患者中位生存时间（平均差异：5．58,95％CI为3．56～7．61,P〈0．01）,但3D-CRT／TMZ不良反应的发生率明显增高（OR=1．54,95％CI为1．14～2．09,P=0．005）。结论3D-CRT/TMZ治疗恶性脑胶质瘤术后患者的有效率、生存率、中位生存时间等疗效显著优于单纯3D-CRT治疗,而不良反应方面高于单纯3D-CRT治疗,但患者一般可耐受。     

Immune Checkpoint Inhibitors for Non-Small-Cell Lung Cancer with Brain Metastasis : The Role of Gamma Knife Radiosurgery

ObjectiveImmune checkpoint inhibitors (ICIs) are approved for treating non-small-cell lung cancer (NSCLC); however, the safety and efficacy of combined ICI and Gamma Knife radiosurgery (GKS) treatment remain undefined. In this study, we retrospectively analyzed patients treated with ICIs with or without GKS at our institute to manage patients with brain metastases from NSCLC. MethodsWe retrospectively reviewed medical records of patients with brain metastases from NSCLC treated with ICIs between January 2015 and December 2017. Of 134 patients, 77 were assessable for brain responses and categorized into three groups as follows : group A, ICI alone (n=26); group B, ICI with concurrent GKS within 14 days (n=24); and group C, ICI with non-concurrent GKS (n=27). ResultsThe median follow-up duration after brain metastasis diagnosis was 19.1 months (range, 1–77). At the last follow-up, 53 patients (68.8%) died, 20 were alive, and four were lost to follow-up. The estimated median overall survival (OS) of all patients from the date of brain metastasis diagnosis was 20.0 months (95% confidence interval, 12.5–27.7) (10.0, 22.5, and 42.1 months in groups A, B, and C, respectively). The OS was shorter in group A than in group C (p=0.001). The intracranial disease progression-free survival (p=0.569), local progression-free survival (p=0.457), and complication rates did not significantly differ among the groups. Twelve patients showed leptomeningeal seeding (LMS) during follow-up. The 1-year LMS-free rate in treated with ICI alone group (69.1%) was significantly lower than that in treated with GKS before ICI treatment or within 14 days group (93.2%) (p=0.004). ConclusionGKS with ICI showed no favorable OS outcome in treating brain metastasis from NSCLC. However, GKS with ICI did not increase the risk of complications. Furthermore, compared with ICI alone, GKS with ICI may be associated with a reduced incidence of LMS. Further understanding of the mechanism, which remains unknown, may help improve the quality of life of patients with brain metastasis.     

抑制 p53 通路促进移植神经干细胞在脑缺血区的存活简

目的探讨一种提高移植神经干细胞（neural stem cells,NSC）在脑缺血区存活的方法。方法原代培养胚胎NSC并鉴定。采用改良Longa线栓法成功制作60只大鼠大脑中动脉阻塞模型,随机分为3组：对照组（n=12）、NSC移植组（n=24）和NSC＋P53抑制剂（pifithrin—α,PFT—α）移植组（n=24）。以上3组在脑梗死模型建立24h后,分别于脑内特定部位注射等量DMEM／F12培养液、NSC悬液和NSC＋PFT-α悬液。细胞移植12h、24h和7d后行免疫荧光染色,检测P53蛋白表达和移植NSC的存活情况。结果移植后12h,NSC移植组P53蛋白主要表达在移植细胞的细胞核,而NSC＋PFT-α移植组P53蛋白的表达主要位于移植细胞的细胞质。移植后7d,NSC＋PFT-α移植组NSC的存活数为（18．20±2．69）／高倍镜视野,NSC移植组为（13．06±3．20）／高倍镜视野,两组间比较差异具有统计学意义（P〈0．05）。结论NSC移植联合PFT-α对提高移植细胞的存活率有重要意义。