姑息性放疗结合化疗治疗肺癌脑转移

目的 评价姑息性放疗结合化疗治疗肺癌脑转移的疗效及副作用。方法 82例非小细胞肺癌脑转移患者在放疗前及放疗后均接受全身化疗。如为颅内多发转移者,给予全颅放疗,中平面剂量33－39Gy/11-13次;如为单个转移者,先给予全颅放疗,中平面剂量30Gy/10次,后缩野加量15Gy/5次。放疗中同时给予20％甘露醇及地塞米松脱水治疗。结果 全组1,2年生存率分别为46．7％和6．7％。伴有颅外转移组1,2年的生存率分别为32．4％和4．4％,仅有颅内转移者生态率为61．2％和8．8％,两组间差异有显著性（P＝0．003）。两组的生态率分别为8个月和12个月。多因素分析显示,原发灶的病理类型、颅内转移灶数与生存率无关。对51例死亡者的调查显示,死于全身广泛转移合并多器官衰竭的占45．1％（23／51）,死于脑转移的占29．4％（15／51）,死亡原发灶的占25．5％（13／51）。在放疗中及以后的随访中,未观察到严重的中枢神经系统并发症。放疗后每月一次的颅脑CT或MR随访中,未发现有明显颅内组织损伤的迹象。结论 单纯颅内转移患者较合并颅外转移的生存率有明显提高,生存率与原发灶的病理类型、颅内转移灶数无明显相关性。

Palliative irradiation combined with chemotherapy for lung cancer with brain metastasis

Objective To evaluate to effects and complications of palliative irradiation combined with chemotherapy for lung cancer with brain metastasis.Methods Eighty two non small cell lung cancer with brain metastasis were treated, of whom 48 had extracranial metastasis simultaneously. All patients received chemotherapy ( Teniposide and cis platin) pior to and also after radiotherapy. The multiple intracranial metastasis patients received whole brain radiation therapy to a dose of 33 39 Gy/11 13fx. The others who had single intracranial lesion received whole brain irradiation of 30 Gy/10 fx and a boost of 15 Gy/5 fx.Results The overall 1 and 2 year actuarial survival rates were 46.7% and 6.7%. For patients with brain metastasis and extracranial lesions, the 1 and 2 year survival rates were 32.4% and 4.4%. For patients with intracranial metastasis only, they were 61.2% and 8.8%, respectively ( P =0.003). The median survival of these two groups were 8 and 12 months . There was no significant correlation between the survivals rate and the histological type or the number of intracranial metastasis. No severe complications were observed during the treatment and follow up.Conclusion The regimen of combined chemotherapy with radiotherapy is effective for lung cancer with brain metastasis. The survival rate of patients with intracranial metastasis only is obviously higher than those with multiple extracranial lesions in addition to brain metastasis. [