X射线立体定向放射外科治疗肺癌脑转移瘤预后因素分析(附79例分析)

Prognostic Factor Analysis for Brain Metastases of Lung Cancer after Stereotactic Radiosurgery(Analysis of 79 cases)

目的:探讨X射线立体定向放射外科治疗(SRS)的肺癌脑转移瘤的局控率及预后因素。方法:回顾性分析1992年4月至2004年6月法国HOPITAL STANNE和HOPITAL TENON收治的79例运用X射线立体定向放射外科治疗的肺癌脑转移瘤。通过临床数据和影象学数据分析颅内肿瘤局部控制率、颅内区域控制率和生存情况。生存分析采用Kaplan-Meier法及Logrank检验,多因素分析采用Cox回归分析模型,统计采用SPSS 10.0统计软件。结果:全组中位生存时间是14个月,1年和2年生存率分别为54.5%、35.6%。多因素分析表明KPS评分(P=0.04)和有无颅外肿瘤病变(P=0.03)是显著的生存预后因素。1年实际局部控制率是86.3%,脑转移瘤的大小(直径<1.8cm)与局控率密切相关(P=0.013)。另外,颅外肿瘤病变是影响颅内区域控制率的因素(P=0.01)。结论:X射线立体定向放射外科治疗(SRS)是有效的安全的治疗脑转移瘤的方法,KPS评分和颅外病变显著影响生存情况,转移瘤的大小明显影响颅内局控率,颅外肿瘤病变是影响颅内控制率的唯一因素。

Objective： To study factors predicting survival and local control in the treatment of brain metastases in patients with lung cancer by stereotactic linac-based radiosurgery. Methods： We have realized a retrospective analysis of 79 lung cancer patients with cerebral metastases treated with LINAC radiosurgery between April 1992 and June 2004, in hospital Tenon and hospital St Anne. Patients were followed-up both clinically and with imaging studies. Demographic data, dose parameters,and other datas were obtained retrospectively. The Cox proportional hazards regression with univariate and multivariate analysis was performed with SPSS 10.0 software. Results： The median survival was 14 months after SRS, the survival at 12 and 24 months were 54.5% and 35.6% , re- spectively. Factors predicting favorable survival in univariate analysis were： Age ≤60 years（ P = 0.0002）, the Karnofsky score 〉 70 （ P = 0.0001 ）, absence of extracranial disease （ P = 0. 004 ） , absence neurological symptoms （ P = 0.001 ）, and combination WBRT（ P = 0. 005）and irradiated volume（ no margin vs. 2mm ）. Multivariate analysis showed that high Karnofsky Performance Score, （KPS）（ P = 0.04） and the absence of extracranial disease had a significant positive effect on survival（ P = 0.03 ）. Conclusion ： Stereotactic radiosurgery was for our series an effective treatment modality for brain metastases. It showed that the KPS 〉 70 and the absence of extracranial disease were factors of a longer survival. The diameter of Metastase （≤1.8cm） was the unique positive significant factor correlated with Local control. The absence of extracranial disease was an independent favorable predicting factors correlated with distant brain control.