全脑三维适形放疗对脑转移瘤的疗效及预后影响因素分析

目的:探讨全脑三维适形放疗对脑转移瘤的疗效及其预后影响因素。方法:选择全脑放疗的恶性肿瘤脑转移病人50例为研究对象，其中28例采用局部加量照射治疗，30例采用放化疗综合治疗。根据WHO实体瘤客观疗效标准和美国放射治疗肿瘤协作组（RTOG）脑肿瘤放疗疗效评价标准评价疗效，采用Kaplan-Meier法统计病人生存率，并分析影响病人预后的相关因素。结果:50例脑转移病人的颅内病灶完全缓解率为4%（2/50），部分缓解率38%（19/50），稳定率50%（25/50），进展率8%（4/50）。总有效率为42%（21/50），疾病控制率为92%（46/50），临床症状缓解率86%（43/50）。中位生存时间为10.2个月，6个月、1年和2年生存率分别为76%、38%和8%。单因素分析显示，放化疗综合治疗较单纯放疗具有更好的生存优势（P<0.01），脑转移瘤灶加量照射地局部控制率有所提高，而对总生存期无明显影响（P>0.05）。多因素分析显示，KPS评分、颅外原发灶是否控制、近期客观缓解率是病人生存率的独立影响因素（P<0.05~P<0.01）。结论:脑转移瘤病人选择全脑三维适形放疗，可缓解临床症状，延长生存期。

Effect of whole-brain 3D conformal radiotherapy and analysis of factors influencing prognosis in brain metastases patients

Objective:To analyze the effects of whole-brain 3D conformal radiotherapy and analysis of factors influencing prognosis in brain metastases patients.Methods:Among 50 patients with malignant tumor brain metastases,28 cases were were irradiated with local dose,and 30 cases were treated with radiotherapy combined chemotherapy.According to the objective curative effect standard of WHO solid tumor and evaluation standard of radiotherapy efficacy of RTOG brain tumor,the curative effect of radiotherapy was evaluated.The survival rate was statistically analyzed using Kaplan-Meier,and the related factors influencing prognosis were analyzed.Results:The total remission rate(CR),partial remission rate(PR),stability rate and progression rate in 50 patients with brain metastases were 4％(2/50),38％(19/50),50％(25/50),and 8％(4/50),respectively.The total effective rate,disease control rate,and remission rate of clinical symptoms were 42％(21/50),92％(46/50)and 86％(43/50),respectively.The median survival time was 10.2 months,and the 6-month,1-and 2-year survival rates were 76％,38％and 8％,respectively.The univariate analysis showed that the radiotherapy combined with chemotherapy had better survival advantage over radiotherapy alone(P <0.01),the control rate of brain metastases increased,and the overall survival rate did not significant be affected(P>0.05).Cox multivariate analysis showed that the KPS score,control of the extracranial primary focus,and objective remission rate were the independent influencing factors in the survival rate of patients(P <0.05 to P <0.01).Conclusions:Three dimensional conformal radiotherapy in the treatment of brain metastases can significantly relieve the clinical symptoms,and prolong the survival of patients.