肺癌脑转移全脑放射治疗联合立体定向放射外科治疗分析

目的 探讨肺癌脑转移患者全脑放射治疗(WBRT)联合立体定向放射外科治疗(SRS)的疗效.方法 56例肺癌脑转移患者接受单纯WBRT(WBRT组,n=35)或WBRT加用SRS加量治疗(WBRT SRS加量组,n=21).WBRT中位剂量30 Gy/10 次,SRS中位剂量15 Gy/次或20 Gy/2次.分析两组患者的中位生存时间、1年生存率、急性放射反应和晚期放射损伤情况.结果 中位随访时间20个月(17～27个月).WBRT组和WBRT SRS加量组的中位生存时间分别为5.3个月(1～19个月)和6个月(1～21个月),1年生存率分别为19.74%和20.68%(P＞0.05),单发脑转移病灶的中位生存时间分别为4.7和10.4个月,但两组的生存曲线无显著差异(P＞0.05).两组的急性放射反应发生率无显著差异(P＞0.05),未观察到严重的晚期放射损伤.结论 对于肺癌单发脑转移灶,WBRT SRS加量治疗患者的中位生存时间长于单纯WBRT,但两者的生存曲线无显著差异.WBRT 30 Gy/10 次加SRS 15 Gy/次或20 Gy/2次是安全可行的.

Analysis of whole brain radiotherapy plus stereotactic radiosurgery in treatment of brain metastases from lung cancer

Objective To assess the therapeutic effect of whole brain radiation therapy(WBRT) plus stereotactic radiosurgery(SRS) in the treatment of brain metastases from lung cancer. Methods Fifty-six patients with brain metastases from lung cancer were treated with WBRT(WBRT group,n=35) or WBRT plus SRS boost(WBRT+SRS boost group,n=21).The median dose of WBRT was 30 Gy in 10 fractions,and the median dose of SRS was 15 Gy in one fraction or 20 Gy in two fractions.The median survival,1-year survival rate,acute radioreaction and later complications were analysed between the two groups. Results The patients were followed up for 17 to 27 months(median,20 months).The median survival for WBRT group and WBRT+SRS boost group were 5.3 months(1 to 19 months) and 6 months(1 to 21 months),respectively,and the 1-year survival rate were 19.74% and 20.68%,respectively(P>0.05).For the single brain metastasis,the median survival for WBRT group and WBRT+SRS boost group were 4.7 and 10.4 months,respectively,while no significant difference was found between the two curves of survival(P>0.05).There was no significant difference in the prevalence of acute radioreaction between the two groups(P>0.05),and no serious later complications were observed. Conclusion The median survival of WBRT plus SRS boost is better than that of WBRT alone for the treatment of single brain metastasis from lung cancer,while there is no significant difference between the two curves of survival.The whole brain irradiation dose of 30 Gy in 10 fractions plus SRS dose of 15 Gy in one fraction or 20 Gy in two fractions is safe and feasible.