放射治疗肺癌脑转移的预后因素分析

An Analysis of Factors Influencing Prognosis After Radiotherapy in Patients with Brain Metastases from Lung Cancer

[目的]探讨不同放射治疗方法对肺癌脑转移的疗效及影响肺癌脑转移的预后因素。[方法]46例肺癌脑转移患者采用放射治疗,共分2组,全脑放疗(WBRT)和全脑放疗加立体定向放射治疗(WBRT+CRT)。CRT治疗单次靶区平均周边剂量3Gy～8Gy,总剂量16Gy～32Gy,WBRT(2～3)Gy/次,总剂量(30～40)Gy/(3～4)w。同时对卡氏评分、合并治疗、颅外有无转移等进行多因素分析。[结果]2组病例局部控制率分别为42.3%、85%。中位生存期分别为5、12.5个月。经多因素分析显示生存率与卡氏评分、合并治疗、颅外有无转移呈正相关。[结论]对于肺癌脑转移,全脑放疗组加立体定向放射治疗(WBRT+CRT)在肿瘤局部控制率及提高生存率方面均优于全脑放疗(WBRT)。对卡氏评分高、合并其它治疗且不存在颅外转移的患者,应采取积极的治疗。

[Purpose ] To evaluate the effieacy of different radiotherapy methods and explore the factors influencing the prognosis after radiotherapy for brain metastases from lung cancer, [ Methods] Fortysix patients with brain metastases from lung cancer were divided into two groups： whole brain radiotherapy （WBRT）; eonformal radiotherapy with whole brain radiotherapy（WBRT＋CRT）. Conformal radiotherapy （CRT） were given with single target dose ranging from 3Gy-8Gy, with a total dose of 16Gy-32Gy, and the total dose of WBRT was 30Gy-40Gy with 2Gy-3Gy per fraction, Karnofsky performance, absence of extraeranial metastases and combined therapy were evaluated with muhivariate analysis. [Results] The tumor local control rates in two groups were 42.3%, 85%, and the median survival was 5, 12.5 months respectively. Multivariate analysis showed that survival has positive correlation with Karnofsky performance, extracranial metastases and combined therapy, [Conelusion] WBRT＋CRT are superior to WBRT, in improving local control rate and survival. Active treatment should be adopted for patients with higher score Karnofsky performance and absence of extracranial metastases.