伽玛刀分期与分次治疗大于3 cm非小细胞肺癌脑转移瘤的疗效比较

目的:回顾性分析伽玛刀分期与分次治疗最大直径大于3 cm的非小细胞肺癌脑转移瘤的疗效与毒副反应，探寻大于3 cm脑转移瘤伽玛刀合适的治疗方案。方法:选取两家伽玛刀中心治疗的128例最大直径大于3 cm的非小细胞肺癌脑转移瘤患者，依据治疗方法分为伽玛刀分期治疗组和伽玛刀分次治疗组，每组64例。比较2组的局控率，生存期，脑转移相关死亡，放射性脑坏死。结果:伽玛刀分期治疗组、伽玛刀分次治疗组1年局部控制率分别为89.1%、68.8%；伽玛刀分期治疗组、伽玛刀分次治疗组中位生存期分别为18个月、13个月；伽玛刀分期治疗组、伽玛刀分次治疗组的脑转移相关死亡率分别为12.5%、35.9%；伽玛刀分期治疗组、伽玛刀分次治疗组放射性脑坏死分别发生3例和1例。结论:伽玛刀分期治疗大于3 cm脑转移瘤疗效更好、毒副反应相当，是合适的治疗选择。

Comparison of gamma knife staging and fractional treatment for brain metastases of non-small cell lung cancer greater than 3 cm

Objective:To retrospectively analyze the efficacy and side effects of gamma knife in staged and fractionated treatment of brain metastasis of non-small cell lung cancer(NSCLC)with a maximum diameter of over 3 cm,and explore the appropriate treatment scheme of gamma knife for brain metastasis of over 3 cm.Methods:128 non-small cell lung cancer(NSCLC)patients with brain metastasis of more than 3 cm inmaximumdiameter were selected from two gamma knife centers.According to the treatment methods,they were divided into staged gamma-knife group and fractionated gamma-knife group,with 64 patients in each group.The local control rate,overall survival time,brain metastasis-related death and radioactive brain necrosis in the two groups were compared.Results:The 1-year local control rate of staged gamma-knife group and fractionated gamma-knife group was 89.1% and 68.8% respectively.The median overall survival time of staged gamma-knife group and fractionated gamma-knife group was 18 months and 13 months.Staged gamma-knife group and fractionated gamma-knife group had brain metastasis-related mortality of 12.5% and 35.9%.There were 3 cases and 1 case of radioactive brain necrosis in staged gamma-knife group and fractionated gamma-knife group.Conclusion:Gamma knife staged treatment for brain metastases larger than 3 cm has better efficacy and similar side effects than fractionatedtreatment,so it is an appropriate treatment choice.