肺腺癌多发脑转移全脑放疗结合化疗的时机与疗效

目的:比较全脑放疗同步化疗与全脑放疗至30Gy时再联合化疗的近期疗效及生存率，以探讨全脑放疗后结合化疗的时机。方法:收集肺腺癌多发脑转移（转移灶>3个）的患者共47例，根据RTOG独立递归分级指数(RPA）先把47例患者分成3层，然后按放化疗的顺序把每层的患者随机分成A、B两组。放射治疗均采取全脑放疗至（40~50）Gy/（20~25）次。化疗方案采用NP方案（培美曲塞二钠+奈达铂）。A组患者全脑放疗并同步给予化疗，B组患者全脑放疗至30Gy再给予化疗。统计学方法用Pearson χ2检验，Fischer's确切概率法检验两组资料入组病例的特征，比较两组的近期疗效、生存率统计及生存曲线绘制采用Kaplain-Meier法，用Log-rank法检测生存率的差异并对各层进行分层分析。结果:A、B两组患者的近期有效率分别为50%与60%(P＞0.05)。A、B两组半年生存率为53.7%与82.2%，1年生存率为10.8%与27.4%，中位生存期分别为7个月与8个月，两组生存率经Log-rank检验， 有统计学差异（P=0.000<0.05）；进一步进行分层分析:第一分层A、B两组的半年生存率为80.2%与100.0%，1年生存率为16.2%与43.6%，中位生存期分别为9个月与11个月，经Log-rank检验，有统计学差异（P=0.000<0.05）；第二分层A、B两组的半年生存率为0与67.3%，1年生存率均为0，中位生存期分别为4个月与7个月，经Log-rank检验，有统计学差异（P=0.000<0.05）；第三分层A、B两组的半年生存率均为0，中位生存期分别为3个月与5个月，经Log-rank检验，有统计学差异（P=0.009<0.05）。结论:全脑放疗至30Gy时再联合化疗较同步放化疗有提高近期疗效的趋势并可延长生存期，对临床治疗具有一定的指导意义。

The efficacy and timing of three -dimensional conformal radiotherapy with chemothera-py for the brain metastasis from adenocarcinoma lung cancer

Objective:To compare the recent efficacy and survival rates between the whole brain radiotherapy with concurrent chemotherapy and radiotherapy to 30Gy whole brain again combined with chemotherapy.To study the better time of the whole brain radiotherapy combined with chemotherapy.Methods:To select 47 patients with brain metasta-sis(the brain metastases more than 3)from adenocarcinoma lung cancer.According to Radiation Therapy Oncology Group(RTOG)brain metastases recursive partitioning analysis(RPA),all patients were divided into 3 layers,and then each layer was randomly divided into two groups A or B by radiotherapy and chemotherapy.All patients were treated by whole brain radiotherapy with the total dose of (40 ~50)Gy/(20 ~25)f,chemotherapy formula:Peme-trexed +NDP.The patients in group A were treated by whole brain radiotherapy concurrent combined with NP regimen chemotherapy,the patients in group B were treated by chemotherapy combined with until whole brain radiotherapy to 30Gy.The baseline characteristics and the differences of the recent efficacy were tested by Pearson χ2 test and Fischer's exact test,the survival rates were estimated by Kaplan -Meier's method,to detect differences in survival rate by Log -rank method and hierarchical analysis of each layer.Results:For 42 patients were end of therapy and followed up,the overall response rates for A and B group were 50% and 60% respectively,P >0.05.Half -year survival rate was 53.7% and 82.2%,one -year survival rate was 10.8% and 27.4%,the median survival times were 7 months and 8 months.By Log -rank test,P =0.000 <0.05.Stratified analysis:The first hierarchical A,B two groups of the half year survival rate was 80.2% and 100.0%,1 year survival rate was 16.2% and 43.6%,the median survival times were 9 months and 11 months.By Log -rank test,P =0.000 <0.05.A,B group two half year survival rate was 0 and 67.3%,1 year survival rate was 0 ,the median survival times were 4 months and 7 months.By Log -rank test,P =0.000 <0.05.The third,hierarchical A,B two groups of 6 months and 1 year survival rate was 0,the median survival times were 3 months and 5 months,according to Log -rank test,P =0.009 <0.05.Conclusion:Treated by whole brain radiotherapy to 30Gy combined with NP regimen chemotherapy has the trends to improve recent efficacy and prolong survival compared with concurrent chemoradiotherapy.