X刀在肺癌脑转移瘤治疗中的作用

X-knife radiosurgery in the treatment of brain metastasis of lung carcinoma

目的探讨X刀在肺癌脑转移瘤常规放射治疗中的价值。方法在2种预后因素(疗前KPS评分及有无远处转移)相同或相似的条件下,配对选择两组各50例,单纯放疗组采用全脑照射30～40Gy/3～4周;X刀联合放疗组中,X刀采用单次照射27例,平均处方剂量14.2Gy,分次照射23例,5～10Gy/次,每周3次,总量达15～30Gy。结果X刀联合放疗组与单纯放疗组比较:中位生存期分别为16.4、10个月(P=0.0064);2年局部控制率分别为88%(44/50)、44%(22/50)(χ2=21.569,P=0.000);治疗后1～3个月头部CT、MRI示有效率分别为87.5%(35/40)、52.2%(24/46)(χ2=16.497,P=0.001)。死因分析,X刀联合放疗组死于脑转移的比例为11.9%(5/42),比单纯放疗组(55.6%,25/45)低(χ2=25.908,P=0.000)。而两组放射并发症发生率相似[8%(4/50)和4%(2/50),χ2=0.709,P=0.400]。结论X刀与常规放疗结合治疗脑转移瘤,疗效优于单纯常规放疗。

Objective To discuss the X-knife radiosurgery （XKS） in the treatment of brain metastasis of lung carcinoma. Methods A total of 100 patients with similar prognostic factors were divided into two groups with 50 patients in each group, receiving either whole-brain radiotherapy alone （30 -40 Gy/3 -4 weeks） （Radiotherapy Group） or XKS combined with radiotherapy （Combination Group）. In the Combination Group, 27 patients received XKS with single fraction of radiation, with a median prescription dose of 14.2 Gy, and the other 23 patients received multiple fractions of radiation （5 - 10 Gy/f, 3 times weekly） , with a total dose of 15 -30 Gy. Results In the Combination Group and the Radiotherapy Group, the median survival time was 16.4 and 10 months, respectively （P =0. 0064）, the 2-year local tumor control rate was 88% （44/50） and 44% （22/50）, respectively （χ^2 = 21. 569,P = 0. 000） , and the effective rate under CT or MRI scanning at 1 - 3 months after treatment was 87.5% （35/40） and 52.2% （24/46）, respectively （χ^2 = 16. 497 ,P = 0. 001 ）. An analysis on the cause of death showed that 11.9% of patients （5/42） in the Combination Group died from brain metastasis, which was significantly lower than that in the Radiotherapy Group （55.6% , 25/45） （χ^2 = 25. 908, P = 0. 000）. The incidence of complications was not significantly different between the Combination Group （8% , 4/50） and the Radiotherapy Group （4% , 2/50） （χ^2 = 0. 709, P = 0. 400）. Conclusions Combined use of X-knife radiosurgery and routine radiotherapy has better therapeutic effects than radiotherapy alone for treating brain metastatic tumor.