脑转移瘤全脑放疗疗效与预后相关因素分析

目的 探讨脑转移瘤患者放射治疗的疗效及相关预后因素。方法 对2013年12月-2018年10月入住我科符合条件的61例初治接受全脑放射治疗的脑转移瘤患者进行回顾性分析，观察患者生存情况和放疗的不良反应，并对预后进行单因素和多因素分析。结果 全组I、Ⅱ、Ⅲ级急性神经系统毒性反应发生率分别为35.3%、10.9%、1.4%；I、Ⅱ、Ⅲ级消化道反应发生率分别为12.1%、4.4%、0.3%；I、Ⅱ、Ⅲ级血液学毒性发生率分别为27.6%、11.7%、2.2%；I、Ⅱ、Ⅲ级急性皮肤损伤发生率分别为6.2%、0.8%、0.1%；无IV级及以上不良反应发生。全组中位生存时间11.9个月，6个月、1年、2年生存率分别为为81.3%、30.6%、12.8%。多因素分析显示肺癌、颅内转移瘤数目和联合化疗为影响患者生存预后的独立因素。结论 全脑放射治疗脑转移瘤安全有效，可有效缓解脑转移瘤患者症状，并延长生存期，原发灶为肺癌、颅内转移癌数目和联合化疗对患者预后起关键作用。

Analysis of factors related to the efficacy and prognosis of brain metastases in whole brain radiotherapy

Objective To evaluate the factors that can affect the prognosis to improve the treatment of brain metastases.Methods A total of 61 patients of brain metastases carcinoma treated with whole brain radiotherapy were analyzed retrospectively from December 2013 to October 2018. The adverse events and survival rates were observed, and prognostic factors were analyzed by single factor and multiple factors analysis.Results No treatment-related deaths occurred, and no patients experienced any grade 4 or above toxicities. The incidence of grade I, Ⅱ and Ⅲ acute neurological toxicity were 35.3%, 10.9%, and 1.4%, respectively. The incidence of grade I, Ⅱ and Ⅲ digestive tract reactions were 12.1%, 4.4%, and 0.3%, respectively. The incidence of grade I, Ⅱ and Ⅲ hematological toxicity were 27.6%, 11.7%, and 2.2%, respectively. The incidence of grade I, Ⅱ and Ⅲ radiation-induced acute skin injury were 6.2%, 0.8%, and 0.1%, respectively. No adverse reactions of grade IV or above occurred. The median survival time was11.9months. The 0.5-,1-and 2-year survival rates were 81.3%,0.6% and 12.8% respectively. Multivariate analysis showed that lung cancer, the number of intracranial metastases and combined chemotherapy were independent factors affecting the survival and prognosis of patients.Conclusion Whole brain radiotherapy for brain metastases is safe and effective, which can effectively alleviate the symptoms of patients with brain metastases and prolong the survival period. The primary lung cancer, the number of intracranial metastases and combined chemotherapy play key role in the prognosis of patients.