立体定向放射治疗脑转移瘤的疗效分析

A Clinical Study on the Treatment of Patients with Multiple Brain Metastases by Stereotactic Radiation Therapy Plus Whole Brain Radiotherapy

[目的]评价立体定向放射治疗在脑转移瘤治疗中的效果与不良反应.[方法]按影响预后因素(年龄、疗前KPS 评分、转移灶数目和病理类型) 配对将住院治疗的82例脑转移癌分为两组.研究组:立体定向放射治疗(SRT) 联合全脑放疗(WBRT)治疗40例;对照组:常规全脑放疗(WBRT)治疗42例.立体定向放射治疗总照射剂量16～30 Gy,每次3～8 Gy,连续或隔日照射4～10次,立体定向放射治疗安排在WBRT之前或之后;常规全脑放疗组剂量为36～40 Gy,连续照射,5次/周.[结果]治疗结束后2个月复查,局部控制率:SRT+WBRT组 CR+PR 22例,总有效率55.0%;WBRT组 CR+PR 13例,总有效率30.9%(P<0.05);4个月后复查,SRT+WBRT组CR+PR 33例,总有效率82.5%,WBRT组CR+PR 20例,总有效率47.6%(P<0.01).研究组与对照组1年生存率分别为80.0%和45.2%(P<0.01).[结论]立体定向放射治疗联合全脑放疗治疗脑转移瘤疗效优于常规放疗.

[Objective]To eveluate the effects of combined Stereotactic radiation therapy（SRT） and whole brain radiotherapy（WBRT） for multiple brain metastases. [Methods]Eighty-two patients （42 to WBRT alone and 40 to WBRT plus SRT）were randomized to initial brain tumor management with WBRT alone （36-40 Gy in 20 fractions） or WBRT plus SRT. The groups were well matched to age, sex, tumor type and number of tumors. For SRT, the planning were designed by Topslane system,radiation was given by 6-MV X-ray, 3-8 Gy per session every day,4-10 times,a total dose of 16-30 Gy were given to planned target volume（PTV）. [Results]The rate of local control at 2 months was 30.9% after WBRT alone and 55% in patients who had WBRT plus SRT（ P〈0.05）. The rate of local control at 4 months was 47.6% after WBRT alone and 82.5% in patients who had WBRT plus SRT（ P〈0.01）. The 1 year＇s survival rates were 45.2% in WBRT alone and 80.0 % in WBRT plus SRT（ P〈0.01 ）. [Conclusion]Stereotactic radiation therapy plus whole brain radiotherapy significantly improves control of brain metastases disease and prolongs the patients＇survival.