乳腺癌脑转移47例三维适形放疗疗效及预后分析

目的 评价三维适形放疗（three-dimensional conformal radiotherapy,3D-CRT）治疗乳腺癌脑转移临床疗效、不良反应以及预后。方法 回顾性分析北京军区总医院放疗科及解放军总医院放疗科1995年5月-2010年10月行全脑放疗（whole brain radiotherapy,WBRT）的47例乳腺癌脑转移患者（PTV 40～50 Gy/20～25 F或PTV 40 Gy/20 F）,脑转移灶（pGTV）同步加量至60 Gy/20 F（或后补量至60 Gy/30 F）,每周放疗5次。部分颅内复发患者再行立体定向放疗10～24 Gy/1～3 F。放疗结束1～3个月后评价疗效、不良反应,观察远期不良反应。结果 47例均完成放疗计划,其中CR 5例（10.6%）、PR 26例（55.3%）、SD 13例（27.7%）、PD 3例（6.4%）,总有效率（CR＋PR）66.0%,临床获益率（CR＋PR＋SD）93.6%。1、2、3年放疗生存率分别为53.2%（25例）、25.5%（12例）、2.1%（1例）,中位生存期13个月。急性不良反应主要为脑水肿、脱发、急性中耳炎、听力下降、皮肤反应、乏力、轻度骨髓抑制,2例（4.3%）出现Ⅲ～Ⅳ级神经系统晚期不良反应。单因素分析显示,放疗生存期与KPS相关。多因素分析显示,患者放疗生存期与KPS、临床分期、脑转移个数（〈3或≥3）、颅内转移灶进展相关。结论 三维适形放疗治疗乳腺癌脑转移能提高局控率,延长生存期;全脑照射40 Gy/20 F安全有效,不良反应可耐受。一般情况越好、临床分期越早、脑转移瘤个数越少、颅内病变进展越晚,生存期越长。

Efficacy and prognosis of three-dimensional conformal radiotherapy in treatment of 47 breast cancer patients with brain metastases

Objective To evaluate the curative effect and adverse effects of three-dimensional conformal radiotherapy （3D-CRT） for breast cancer patients with brain metastases. Methods Clinical data about 47 breast cancer patients with brain metastases admitted to The Military General Hospital of Beijing PLA and Chinese PLA General Hospital from May 1995 to October 2010 who underwent the whole brain radio therapy （WBRT） were retrospectively analyzed. The doses of WBRT was 50 Gy in 2 Gy fractions, or 40 Gy in 2 Gy fractions with simultaneous integrated boost to multiple brain metastases （DT 60 Gy in 3 Gy fractions）. Part of the patients underwent stereotactic radiotherapy with 10-24 Gy/1-3 F. The curative effect and adverse reactions were evaluated for one to three months after radiotherapy. Results All patients were followed up for 2-49 months. CR was observed in 5 cases （10.6%）, PR in 26 cases （55.3%）, SD in 13 cases （27.7%）, PD in 3 cases （6.4%）, and the clinical response rate was 66.0%. 1, 2 and 3 years survival rates of brain metastases to death were 53.2%, 25.5% and 2.1% respectively, and the median survival time was 13 months. The main adverse reactions were radiation-induced cerebral edema, alopecia, tympanitis, hearing loss, dermoreaction, acratia, marrow suppression, impaired memory and Ⅲ - Ⅳ nervous system side effects. The univariate analysis showed that KPS （ 〈 50 and ≥ 60） （t=4.37, P=0.00） was a significant prognostic factor of overall survival time. The mutivariate analysis showed that KPS （u=3.05, P=0.00）, AJCC stage （u=2.09, P=0.04）, brain metastasis number （ 〈 3 and ≥ 3） （u=1.94, P=0.05） and intracranial progress （u=2.21, P=0.03） were significant prognostic factors of overall survival time. Conclusion 3D-CRT can improve the local control rate of breast cancer patients with brain metastases, and prolong the survival time with few adverse effects. It is safe for patients treating with whole brain radiotherapy （DT 40 Gy, 2 Gy/fraction）. Pat