放射治疗脑转移瘤130例临床分析

Radiotherapy for 130 patients of Brain metastatic neoplasm

目的:探讨脑转移瘤病人的预后因素及不同治疗方法对其的影响。材料和方法:本文对1977.5至1996.5收治的脑转移瘤130例病人进行回顾性分析。原发肿瘤为肺癌的118例,其它来源的为12例。所有病人给予全脑放疗,其中,辅以手术的17例;辅以化疗的63例。结果:中位生存期为10个月。1年生存率为32％。年龄≤65岁、单发转移灶、无其它部位转移者预后好;原发乳腺癌的脑转移瘤病人比原发肺鳞癌及小细胞肺癌的预后好。放疗剂量≥60Gy组与<60Gy组比较,有效率由33％提高至100％(这P<0.01),但其晚期损伤发生率也由0提高至75％(P<0.05)。结论:放疗对脑转移瘤有很好的姑息效果,但通过增加放疗剂量而提高疗效有一定困难,对部分病人,尤其是首程放疗复发者,采用手术,X—刀式7—刀加全脑放疗方法治疗脑转移瘤不失为一种十分有效的方法。

Purpose:To evaluate correlative factor of survival of the patients with brain metastatic neoplasm and the effect of different methods of treatment. Methods: 130 patients of brain metastasis treated with radiotherapy between May 1977 and May 1996 were reviewed. The primary tumour came from the lung in 118 patients,from the other regions in 12 patients. All of the patients and 63 patients, by the adjuvant chemotherapy. Results:Median surviual time was 10 months. The one year survival time was 10 months. The one year survival rate was 32%. The data showed that four factors influenced the survival: they are ages, extracranial metastasis, number of brain metastasis and pathological diagnosis. The tumor control rate for the radiotherapy dose≥60Gy and,<60Gy groups were 100% and 33%. This difference was statistically significant (P<0. 01). At the same time, the rate of late complications for radiotherapy dose≥60Gy and <60Gy groups were 75% and 0. This difference was also statistically significant(P>0. 05). Conclusion:Radiotherapy have good palliative effect for brain metastatic neoplasm. It is diffi-cult to improve the tumor control rate by increasing the dose. The combine surgery and radiotherapy or radiosurgery and radio-therapy, is one of the best methods for treating the brain metastasis, especially for recurrent tumors after radiotherapy.