非小细胞肺癌脑转移行伽马刀及全脑放射#br#治疗的效果及预后的影响因素分析#br##br#

目的探讨立体定向放射治疗(SRT)及全脑放射治疗(WBRT)对非小细胞肺癌(NSCLC)脑转移患者的疗效,分析患者生存预后的影响因素。方法选择2014年6月至2016年1月在东北国际医院接受放疗的140例NSCLC脑转移患者,根据放疗方式不同分为WBRT组(59例)和SRT组(伽马刀,81例)。比较两组患者放疗后3个月的近期疗效、不良反应发生情况及生存情况,绘制Kalpan Meier生存曲线比较两组患者的颅内疾病无进展生存期(PFS)和总生存期(OS);通过Cox比例风险回归模型分析患者生存预后的影响因素。结果SRT组的总有效率高于WBRT组(7531％ vs. 5085％),SRT组的不良反应中恶心呕吐(7531％ vs. 8983％)、昏迷(7037％ vs. 8474％)及急性放射性神经系统损害发生率(7901％ vs. 9322％)显著低于WBRT组,差异均有统计学意义(P<005)。SRT组的中位OS、PFS分别为140(75,285)、75(30,210)个月,均长于WBRT组的60(35,105)、30(15,55)个月,差异均有统计学意义(P<005)。GPA评分低、有颅外转移和颅脑放疗方式WBRT均为NSCLC脑转移患者预后的危险因素。结论伽马刀放射治疗NSCLC脑转移的近期疗效显著,可延长患者生存期并减少不良反应,对具有良好预后因素的患者施行伽马刀放射治疗可能会收到更好的临床疗效。

Analysis of efficacy and prognostic factors of gamma knife radiotherapy and whole brain radiotherapy in patients with brain metastases from non-small cell lung cancer

Objective To explore the curative effect of Stereotactic Radiotherapy(SRT)and Whole Brain Radiotherapy(WBRT)on patients with brain metastases from Non-small cell lung cancer(NSCLC),and to analyze prognostic factors affecting patient survival.Methods From June 2014 to January 2016,140 patients with NSCLC brain metastases who received radiotherapy in our hospital were selected and were divided into WBRT group(59 cases)and SRT group(Gamma Knife,81 cases)according to the radiotherapy method.The short-term efficacy within 3 months,occurrence of adverse reactions and survival after radiotherapy in the two groups were compared,Kalpan-Meier survival curves were drawn to compare the intracranial disease progression-free survival(PFS)and overall survival(OS)of patients in the two groups.Cox proportional hazards regression model was used to analyze the factors affecting the survival and prognosis of patients.ResultsThe total effective rate of SRT group was higher than that of WBRT group(75.31%vs.50.85%),and the incidence of nausea and vomiting(75.31%vs.89.83%),coma(70.37%vs.84.74%)and acute radioactive nervous system damage(79.01%vs.93.22%)in SRT group were significantly lower than that of WBRT group,with statistically significant differences(P<0.05).The median OS and PFS in SRT group were 14.0(7.5,28.5)and 7.5(3.0,21.0)months,respectively,which were both longer than 6.0(3.5,10.5)and 3.0(1.5,5.5)months in WBRT group,with statistically significant differences(P<0.05).Low GPA score,extracranial metastasis,and craniocerebral radiation therapy(WBRT)are all risk factors for the prognosis of patients with NSCLC brain metastases.Conclusions Gamma knife radiotherapy has a significant short-term effect,which can prolong the survival time of patients and reduce adverse reactions.Gamma knife radiotherapy for patients with good prognostic factors may have better clinical efficacy.