非小细胞肺癌脑转移患者全脑放疗不同剂量预后分析

目的:分析非小细胞肺癌(NSCLC)脑转移患者不同全脑放疗(WBRT)剂量的预后及影响因素。方法:回顾性分析2013—2015年间于河北医科大学第四医院行WBRT的244例NSCLC脑转移患者。按照不同WBRT剂量(EQD 2Gy)分为30~39 Gy组104例、≥40 Gy组140例。比较两组患者颅内无进...

Prognostic analysis of patients with brain metastases from non-small cell lung cancer treated with different doses of whole brain radiotherapy

Objective To analyze the prognosis and influencing factors of patients with brain metastases from non-small cell lung cancer (NSCLC) treated with different doses of whole brain radiotherapy (WBRT). Methods A total of 244 NSCLC patients with brain metastases who underwent WBRT in the Fourth Hospital of Hebei Medical University from 2013 to 2015 were analyzed retrospectively. According to different doses of WBRT (EQD2Gy), they were divided into the 30-39Gy group (n= 104) and ≥40Gy group (n= 140). The intracranial progression-free survival (iPFS) and overall survival (OS) were compared betweentwo groups. According to the number of brain metastases, GPA score, KPS score, chemotherapy and targeted therapy, the prognosis of different doses of WBRT was further analyzed. Results The median iPFS and OS of all patients were 6.9 months and 11.8 months, respectively. Univariate survival analysis:the 1-year iPFS and 1-year OS between two groups were 22.5% and 25.4%(P=0.430) and 41.1% and 46.4%(P=0.068), respectively. Multivariate survival analysis:different doses of WBRT were not associated with the improvement of iPFS and OS;independent factors influencing iPFS included local boost, gender, number of brain metastases, chemotherapy and targeted therapy;independent factors influencing OS included gender, number of brain metastases, chemotherapy and targeted therapy. Subgroup analysis:in patients with KPS≥90, the 1-year iPFS and OS of patients with WBRT ≥ 40Gy were seemingly better than those of their counterparts with 30-39Gy, but the difference was statistically significant only in OS (P=0.047), the difference was not statistically significant in iPFS (P=0.068);in patients with chemotherapy, the 1-year iPFS and OS of patients with WBRT≥40Gy were better than those of their counterparts with 30-39Gy (P=0.017, P=0.012);in patients with targeted therapy, the 1-year iPFS and OS in the WBRT≥40Gy group were better than those in the 30-39Gy group (P=0.012, P=0.045). Conclusions The 30-39Gy may be the appropriate dose of WBRT for NSCLC patients with brain metastases. WBRT≥40Gy does not bring more benefits. WBRT≥40Gy may benefit NSCLC patients with brain metastases with high KPS score or active systemic therapy.