全脑适形调强放疗同步加量治疗脑转移瘤疗效分析

目的探讨全脑适形调强放疗（IMRT）同步加量治疗脑转移瘤的剂量学优势、患者依从性、疗效和预后因素。方法回顾性分析41例脑转移瘤患者临床资料，均经增强脑CT或磁共振成像（MRI）证实为脑转移，均接受全脑IMRT同步加量，大体肿瘤体积（GTV）（影像学可见的脑转移灶）：DT4994～6990cGy／22—30次，每4．4—6．0周；全脑：DT3990～5000cGy／22～30次，每4．4—6．0周。结果中位随访时间6．4个月。41例患者均完成整个放疗过程，其中完全及部分缓解27例，未控11例，其余3例无治疗后影像资料对照，缓解情况不详。总有效率、中位生存时间、1年生存率分别为65．8％、8个月、24．4％。脑干、脊髓、左晶体、右晶体、左视神经、右视神经、视交叉接受的最高剂量平均值分别为48．7、32．4、7．3、7．0、40．2、39．5、47．1Gy，均在安全剂量范围之内，仅21例发生放射性脑水肿，其余未出现早期及晚期放射性不良反应。结论脑转移瘤接受全脑IMRT同步加量可使靶区剂量分布均匀，有效保护脑干和其他重要器官，患者治疗依从性高，可作为脑转移瘤患者的一种有效治疗方法。

Efficacy analysis of whole brain confomal intensity-modulated radiation therapy combined with synchronous dosage for treatment of brain metastases

Objective To discuss dosimetric advantage, compliance, efficacy and prognostic factors of whole brain conformal intensity-modulated radiotherapy （ IMRT ） combined with synchronous dosage for treatment of brain metastases. Methods Forty-one patients with metastatic tumor to the brain were confirmed by computed tomography （CT） or magnetic resonance imaging （MRI）. They received whole brain irradiation and simultaneous integrated boost to bulky metastases by IMRT. Gross tumor volume（GTV） DT 4994-6990 cGy/ 22-30 fractions/4.4-6.0 weeks,whole brain DT 3990-5000 cGy/22-30 fractions/4.4-6.0 weeks. Results The median follow-up time was 6.4 months.The overall response rate,the median survival time and the overall survival at 1 year were 65.8 %, 8 months, 24.4 %. The brain-stem, spinalcord, lens, opticnerves were in the limited dose. In 21 patients, radioactive brain edema was happened, the rest did not appear early and late radiation reaction. Conclusion Whole brain irradiation using simultaneous integrated boost to bulky lesion by IMRT show an improvement in dose distribution and significant effect to patients with brain metastases. The therapy is well-tolerated and effective.