全脑放射治疗配合立体定向放射治疗治疗脑转移瘤

Whole brain radiotherapy combined with stere otactic radiotherapy in the treatment of brain metastasis

目的 探讨X线立体定向放射治疗在脑转移瘤常规放射治疗中的作用。方法 在4种预后因素（年龄、疗前KPS评分、有无其它远处转移及转移灶数目）相同或相似的条件下，配对选择两组病例，全脑放疗加X线立体定向放射治疗组40例，为研究组；常规放疗组50例，为对照组。对照组全脑放疗剂量为30～40Gy／2～4周；研究组在对照组的基础上加用立体定向放射治疗，使用共面或非共面多野照射，采用每次剂量4～6Gy，每周3次，总剂量24～30Gy。结果 研究组与对照组比较：1年生存率分别为82．5％和50.0％，治疗后3个月影像学有效率（CR＋PR）分别为92．5％和66．0％，治疗3个月后KPS评分好转的比例分别为85．0％和52．0％，因脑转移死亡率分别为10％和48％，以上结果经统计学处理均有显著性差异（P〈0．01），两组病例的并发症发生率相似。结论 全脑放射治疗配合X线立体定向放射治疗治疗脑转移瘤疗效优于单纯常规放疗。

Objective To study the effect of whole brain radiotherapy combined with X-ray stereotactic radiotherapy in the radiotherapy treatment of brain metastases. Methods 90 subjects of the same or similar age,KPS score before treatment,with or without distant metastasis and number of metastasis were diveded into two groups： 40 cases were treated with whole brain radiotherapy combined with stereotactic radiotherapy as treatment group, 50 cases were treated with whole brain radiotherapy as control group. The radiation dose of control group was 30～40 Gy in 2～4 weeks. The treatment group received ooplanarity or noncoplanarity irradiation,4～6 Gy per fraction,three fractions a week with total dose of 24～30Gy. Results The 1-year survival rate was 82.5% for ytreatment group and 50. 0 % for control group. The rote of validity after 3-month treatment was 92.5 % and 66.0 %, respectively. The rate of KPS score increasing after 3-month treatment was 85.0% and 52%, respectively. The mortality for brain metastasis was 10% and 48%, respectively. There was significant difference between two groups（ P 〈 0.01 ）. Complication for two groups was almost the same. Conclusion Effect of whole brain radiotherapy combined with X-ray stereotactic radiotherapy is better than routine radiotherapy alone in the treatment of brain metastases.