立体定向放射外科分期治疗大体积脑转移瘤的疗效及安全性分析

Efficacy of stereotactic radiosurgery staging in the treatment of massive brain metastasesand safety analysis

目的探讨立体定向放射外科分期治疗大体积脑转移瘤的疗效、安全性及影响预后的相关因素。方法收集52例采用立体定向放射外科分期治疗的大体积脑转移瘤患者的临床资料。给予二周期的放射外科治疗,首期治疗的中位周边剂量为12 Gy(10~13),治疗中位间期为28天(25~47天),二期治疗的中位周边剂量14 Gy(12~15)。在二期治疗结束后与治疗前影像资料对比评价近期疗效,随访观察远期疗效及安全性。结果3个月ORR为46.2%,一年LCR为88.5%,6个月总生存率为74.8%,1年内总生存率为62.2%,中位OS为11.25个月(3.15~15.3个月),PFS为9.16个月(4.25~13.7个月)。治疗前45例患者存在明显神经系统症状,经过治疗后42例患者(93.3%)临床症状明显改善,中位KPS评分由60分提升至80分。治疗后9例患者(17.3%)出现1-2级急性CNS放疗副反应,1例患者(1.92%)出现3-4级急性CNS放疗副反应,经对症治疗后均缓解。结论立体定向放射外科分期治疗大体积脑转移瘤,肿瘤局控率较高,且能在最短时间内减轻颅内肿瘤负荷(指的是肿瘤过大引起的占位效应),明显改善神经系统不良症状,提高患者生存质量,不良反应较少,安全性高,是大体积脑转移瘤局部治疗的有效手段之一。肿瘤体积、肿瘤周边剂量及肿瘤位置是影响患者局控率的因素;原发病灶未控,GPA评分、RPA分级及KPS评分均是患者生存状况的影响因素。

Objective To investigate the efficacy,safety and prognostic factors of stereotactic radiosurgery staging for massive brain metastases.Methods The clinical data of 52 patients with massive brain metastases treated by stereotactic radiosurgery were collected.Two cycles of radiosurgery were given.The median peripheral dose of the first phase was 12 Gy(10-13),the median treatment interval was 28 days(25-47 days),and the median peripheral dose of the second phase was 14 Gy(12-15).After the second stage treatment,the short-term efficacy was evaluated by comparing the imaging data before and after treatment,and the long-term efficacy and safety were observed.Results The 3-month ORR was 46.2%,the 1-year LCR was 88.5%,the 6-month overall survival rate was 74.8%,the 1-year overall survival rate was 62.2%,the median OS was 11.25 months(3.15~15.3 months),and the PFS was 9.16 months(4.25~13.7 months).45 patients had obvious nervous system symptoms before treatment,42 patients(93.3%)had obvious improvement in clinical symptoms after treatment,and the median KPS score was increased from 60 to 80.After treatment,9 patients(17.3%)had grade 1-2 acute CNS radiotherapy side effects,and 1 patient(1.92%)had grade 3-4 acute CNS radiotherapy side effects,which were alleviated after symptomatic treatment.Conclusion Stereotactic radiosurgery in staging treatment of massive brain metastases has a high local tumor control rate,can reduce the intracranial tumor load in the shortest time,significantly improve the adverse symptoms of the nervous system,and improve the quality of life of patients.With fewer adverse reactions and high safety,it is one of the effective methods for local treatment of massive brain metastases.Tumor volume,tumor peripheral dose and tumor location were the factors influencing the local control rate of patients;The primary lesion was not controlled,GPA score,RPA grade and KPS score were the influencing factors for the survival of patients.