脑转移瘤治疗方法的对比研究

目的比较手术结合全脑放疗、X-刀和X-刀结合全脑放疗治疗单发脑转移瘤的效果。方法回顾分析我院自1996年2月至2000年4月间经手术结合放射治疗的脑转移瘤84例、X-刀和X-刀结合全脑放疗治疗的脑转移瘤102例,从中选择符合条件的脑转移瘤患者86例,分成3组:手术结合全脑放疗组36例;X-刀组32例;X-刀结合全脑放疗组18例。从临床症状变化,生存时间,局部控制率,肿瘤脑远隔部位生长率,因中枢神经系统病变死亡率等方面比较三种方法的疗效。结果手术结合全脑放疗组、X-刀组和X-刀结合全脑放疗组的临床有效率分别为86.1%(31/36),87.5%(28/32)和88.9%(16/18);中位生存时间分别为54周,50周和51周;1年生存率分别为47.2%(17/36),43.8%(14/32)和44.4%(8/18)。1年肿瘤局部控制率分别为83.3%(30/36),78.1(25/32)和77.8%(14/18)。因中枢神经系统病变死亡率分别为26.7%(8/30),30%(6/20)和28.6%(4/14),三组之间无明显差异(P>0.05)。肿瘤脑远隔部位发生率分别为13.9%(5/36),37.5%(12/32)和11.1%(2/18),X-刀组明显高于其他两组(P<0.05)。结论对于单发脑转移瘤,单纯X-刀可以获得与手术结合全脑放疗和X-刀结合全脑放疗相同的生存时间、局部控制率;全脑放疗可降低肿瘤脑远隔部位生长率,但对生存时间和局部控制率无明显影响。

Observation of Curative Effects of Three Different Method on Metastases of Tumor to Brain

Objective To compare the curative effects of surgery plus whole-brain radiotherapy(WBRT),single X-knife and X-knife plus WBRT on the patients with single brain metastasis(BM).Methods Between February1996and April2000,84patients with BM received WBRT after the operation for BM and102underwent X-knife or X-knife plus WBRT for BM in our hospital.Eight-six patients who were fit for the study were chosen and divided into three groups:operation plus WBRT group(36patients),X-knife group(32patients)and X-knife plus WBRT group(18patients).The curative effects among the three groups was compared.Results The clinically effective rate was86.1%(31/36)in the operation plus WBRT group,87.5%(28/32)in the X-knife group and88.9%(16/18)in the X-knife plus WBRT group.The median survival time was54weeks in the operation plus WBRT group,50weeks in the X-knife group and51weeks in the X-knife plus WBRT group.The1-year survival rate was47.2%(17/36)in the operation plus WBRT group,43.8%(14/32)in the X-knife group and44.4%(8/18)in the X-knife plus WBRT group.The1-year local tumor control rate was83.3%(30/36)in the operation plus WBRT group,78.1%(25/32)in the X-knife group and77.8%(14/18)in the X-knife plus WBRT group.The CNS disease mortality was26.7%(8/30)in the operation plus WBRT group,30%(6/20)in the X-knife group and28.6%(4/14)in the X-knife plus WBRT group.There is insignificant difference in the above indices among the three groups(P>0.05).In the brain area distant to the tumor,tumor recurrence rate(37.5%)in the X-knife group was higher than those in the operation plus WBRT group(13.9%)and in the X-knife plus WBRT group(11.1%)(P<0.05).Conclusions X-knife is as effective as operation plus WBRT or X-knife plus WBRT in terms of survival time and local tumor control rate in the patients with single BW.WBRT can reduce the tumor recurrence rate in the brain area distant to the tumor,but it has no the effect on survival time and local tumor control rate in the patients with BW.