非小细胞肺癌脑转移的治疗

The Effect of Treatment for Non-small-celled Brain Metastasis Tumor of Lung Cancer

目的在原发病得到控制的情况下，比较单发的非小细胞肺癌脑转移瘤治疗方法的效果。方法1990年1月-2004年12月对125例单发的非小细胞肺癌脑转移瘤的患者实施单纯放疗及手术切除加放疗，全脑照射30～40Gy／2—3周后，再缩野局部追加15～20Gy／1．5—2周。立体定向放疗应用γ-刀治疗。结果手术切除加放疗的中位生存期10．5个月和一年生存率64．5％显著优于单放组的6．3个月和14．9％（P〈0．05）。单纯的立体定向放疗中位生存期9．6个月和一年生存率61．8％显著优于单纯的全脑照射组的6．3个月和14．9％（P〈0．05）。但这组资料分析结果不能表明手术和立体定向放疗那一种更好。结论单发的非小细胞肺癌脑转移采用手术加放疗比单纯放疗效果好。单纯的立体定向放疗优于单纯的全脑照射。立体定向放疗和传统的外科手术切除的结果相同。

Objective This paper has compared the effect of treatment for solitary non - small - celled brain metastasis tumor of lung cancer on the condition that primary illness has been controlled. Methods 125 solitary non - small - celled brain metastasis tumor of lung cancer patients were treated by radiotherapy alone as well as by surgery excising followed by radiotherapy from January in 1990 to December in 2004. After 2 or 3 weeks of the whole brain radiotherapy （WBRT） 30 - 40Gy, then it were restricted to local parts, also coupled with 15 -20Gy for 1, 5 - 2 weeks. Stereotactic radiosurgery （SRS） was done by γ scapel. Results The ten and a half - month median survival period and 64.5% of one - year surviral rate of surgery excising followed by radiotherapy were obviously superior to that of 6. 3 months and 14. 9% （P 〈0.05） in Radiotherapy group alone. 9. 6 months of median survival period and 61.8% of one - year survival rate followed by stereotactic radiotherapy alone were obviously superior to the whole brain radiotherapy group with 6.3 months and 14.9% （ P 〈 0. 05 ）. However, the analysis results of these materials do not indicate which is better between the surgery and stereotactic radiosurgery. Conclusions Solitary non - small - celled brain metastasis of lung cancer has better effect followed by surgery combined with radiotherapy than by radiotherapy alone. Stereotactic radiosurgery alone is superior to the only whole brain radiotherapy. Stereotactic radiosurgery produces the same result with that of the traditional surgery excising.