肺癌脑转移的三维适形放疗

Three Dimension Radiotherapy of Lung Cancer with Brain Metastasis

目的通过观察分析适形放疗病例的结果，探讨三维适形放疗对肺癌脑转移的临床意义。方法共35例肺癌脑转移患者，其中合并颅外转移12例，非颅外转移23例。所有患者均首先经全脑放疗1．8-2Gy／次，5次／周，总量计Dr30-40Gy。然后行适形放疗，90％的等剂量曲线包括靶区；分割剂量则根据靶区大小分为Dr2～6Gy／次，5次／周，累计适形放疗剂量为20～40Gy。结果有效率（CR＋PR）为85％（30／35）。治疗前脑部肿瘤直径〈3cm患者肿瘤缩小要优于直径〉3cm者。生存时间：中位生存期10．3个月。结论三维适形放疗可以提高转移灶剂量，对于提高病灶的局控率明显有效，可以降低死于脑部病变复发比例。三维适形放疗在治疗脑转移的同时，颅外转移灶及原发灶的治疗也非常重要。

Objective Through the observation of result of conformal radiotherapy,to explore the clinical significance of three dimension conformal radiotherapy to treat the brain metastasis of lung cancer. Methods There have 35 case patients of lung cancer with brain metastasis,and 12 of them combined with extracranial metastasis, and the other 23 cases don＇t exist extracranial metastasis. All patients were treated by whole brain irradiation, 1.8-2 Gy/time for 5 times/week, and the total dosage was 30-40Gy. And then were treated by conforrnal radiotherapy,the 90% equi-dosage line include the target area; fraction dosage was 2-6Gy/time and 5 times/week according to the size of target area,and the accumulative radiotherapy dosage was 20-40Gy. Results the effective rate（CR＋ PR）was 85%（3（1/35）. the effect of patients with brain tumor size less than 3cm before treatment was superior to that of excess of 3cm. Survival time：the median survival time was 10. 3 month. Conclusion The three dimension conformal radiotherapy can increase the dosage of metastasis focus,and have significant effect of improving local control rate of focus,and can reduce the death rate died of brain focus recurrence. At the mean time when we use the three dimension conformal radiotherapy to treat brain metastasis,it is also important to treat extracranial metastasis and primary tumor.