非小细胞肺癌脑转移低分割放疗疗效分析

目的评价非小细胞肺癌脑转移放射治疗中全脑照射的作用，分析生存预后因素。方法对93例非小细胞肺癌脑转移患者进行放射治疗，其中68例先行全脑照射（全脑照射组），然后行局部三维适形低分割放疗；25例只行三维适形低分割放疗（低分割组）。用Kaplan-meier法统计生存率及局部控制率，以Cox比例风险模型分析影响患者生存的预后因素。结果全脑照射组中位生存时间14个月，1、2年生存率分别为50％、27％；低分割组中位生存时间12个月，l、2年生存率分别为45％、15％；两组无显著差异性（10g-rank，P=0．502）。全脑照射组与低分割组1年颅脑局部控制率分别为90％、70％，两组有显著差异（P=0．028）。多因素分析提示颅外活动性病灶（P=0．002）、KPS评分（P=0．034）是影响生存的独立预后因素。结论非小细胞肺癌脑转移三维适形放疗联合全脑照射无生存得益，而有助于提高局部控制率。

Three-dimensional conformal hypofractionated radiotherapy for brain metastases of non-small-cell lung carcinoma: implications for whole brain irradiation]

OBJECTIVE: To evaluate the therapeutic effect of of whole brain irradiation (WBI) in the treatment of brain metastases of non-small-cell lung carcinoma and analyze the factors affecting the patients' survival. METHODS: Ninety-three cases of brain metastases of non-small-cell lung carcinoma receiving radiotherapy between January 1998 and February 2004 were retrospectively reviewed. Of these patients, 68 were treated with three-dimensional conformal hypofractionated radiotherapy (3D-CRT) following WBI, while the other 25 underwent 3D-CRT alone. Kaplan-Meier method was used to analyze the survival rate and local control rate, and Cox proportional hazards model employed for determining prognostic factors influencing the patients' survival. RESULTS: The overall median actuarial survival of the patients was 14 months in the 3D-CRT+WBI group with 1- and 2-year actuarial survival rates of 50% and 27%, respectively, showing no significant difference from 3D-CRT group, which had a median survival of 11 months and 1- and 2-year survival rates of 45% and 15% (P=0.502, log-rank test). Actuarial 1-year local control rate in 3D-CRT+WBI group was 90% as compared to 70% in 3D-CRT group (P=0.028, log-rank test). In multivariate analyses, active extracranial disease (P=0.002) and Karnofsky Performance Scale score (P=0.034) were identified as the independent prognostic factors for the patients' survival. CONCLUSION: WBI prior to 3D-CRT does not benefit the patients with brain metastases of non-small cell lung carcinoma for their survival, but may help improve the local control rate.