X射线立体定向放射治疗配合全脑照射治疗脑转移瘤疗效分析

目的　分析X射线立体定向放射治疗(SRS)配合全脑照射治疗脑转移瘤的作用。方法　对55例脑转移瘤患者进行SRS配合全脑照射，17例行单纯SRS治疗。全脑照射采用8?MVX射线，1.5～2.0Gy/次，DT30～42 Gy,4～5周；SRS处方剂量为18～30 Gy，SRS前行全脑放射治疗39例，SRS后行全脑放射治疗16例。结果　SRS加全脑照射组病变完全消失(CR)占60.0%，部分消失(PR)占32.7%，无变化(NC)占7.3%，总缓解率(CR+PR)为92.7%；与单纯SRS组的35.0%、41.2%、23.5%、76.2%相比差异无显著性意义（χ2=3.47,P＞0.05）。SRS加全脑照射组复发率为14.5%,中位复发时间为10个月，中位生存时间为13个月；与单纯SRS组的41.2%、4个月、7.5个月相比差异有显著性意义(χ

Stereotactic radiosurgery supplementing total brain irradiation in the treatment of brain metastases

Objective　To analyse the impact of combined regimen of total brain irradiation (TBR) and X-ray stereotactic were 10 months, 14.5% (8/55) and 13 months in the SRS plus TBR group, as compared with 4 months ,41.2% (7/17) and 7.5 months in the S radiosurgery (X-knife,SRS) on brain metastases. Methods　From October, 1997 to December, 1999, 55 patients with brain metastases were treated by SRS plus TBR and 17 patients by SRS alone. The dose of TBR was 30～42Gy/4～5 weeks, 1.5～2.0 Gy per fraction and that of SRS 18～30Gy. Results　The overall response rates (CR+PR) were 92.7% in the TBR plus SRS group , and 76.2% in the SRS alone group with significant difference (P＞0.05). The median recurrent period , recurrent rate and median survival period were 10 months,14.5%(8/55) and 13 months in the TBR plus SRS group, as compared with 4 month's,41.2%(7/17) and 7.5 months in the RS alone group (P<0.05). The differences approached only near to statistical significance. The 1-year survival and mortality rates were 63.6%, 36.4% and 41.7%,52.9% in the above groups (P＞0.05). Conclusions　For brain metastases, irradiation of the entire intracranial contents combined with stereotactic radiosurgey (X-knife) has a significant impact on improving the local contol and ultimate outcome.