短程全脑放疗在非小细胞肺癌脑转移病人中的疗效观察

Observations on the treatment effect of whole-brain radiotherapy on patients of NSCLC with brain metastasis and prognostic factor

目的探讨非小细胞肺癌脑转移病人的全脑放疗的疗程以及影响其预后的因素。方法分析101例非小细胞肺癌脑转移全脑放疗病人,其中35例接受5天5×4GY的放疗,另外66例接受2周10×3GY或4周20×2GY的放疗,同时观察6个可能影响预后的因素:包括年龄、性别、KPS、脑转移灶数、是否有颅外转移灶、肺癌确诊到全脑放疗时间、递归分割分析级别。结果全脑放疗的疗程与生存率没有相关性,通过单变量分析:(年龄<60岁:年龄≥60岁,P=0.020)、(KPS≥70:KPS<70P<0.001)、肿瘤确诊到接受全脑放疗时间(>12月:≤12月P=0.007)、有无颅外转移(P<0.001),提高生存率与这些因素有显著相关性。结论短程的5×4GY更容易被大部分非小细胞肺癌脑转移病人所接受,因为它与长程放疗生存率相似,短程放疗节约治疗时间、节省治疗费用。

Objective To discuss the course of treatment of whole-brain radiotherapy （WBRT） on patients in non-small cell lung cancer （NSCLC） with brain metastasis and prognostic factor. Methods Data from 101 NSCLC patients treated with WBRT for brain metastases were retrospectively analyzed. The 35 patients who received 5 × 4 Gy given in 5 days were compared in the survival rate with 66 patients who received either 10 ×3 Gy given in 2 weeks or 20 × 2 Gy given in 4 weeks. Six further potential prognostic factors were investigated for survival including age, sex, Karnofsky performance score（ KPS）, number of brain metastases, extracranial metastases, interval from tumor diagnosis to WBRT. Results The WBRT regimen was not associated with survival （ P = 0. 55 ）. On single analysis, （ age 〈 60 years vs 〉 60 years, P = 0. 020）, （ KPS 70 vs KPS 〈 70, P 〈 0. 001 ）, （ interval from tumor diagnosis to WBRT 〉 12 months vs 12 months, P = 0. 007 ）, no extracranial metastases （P 〈 0. 001 ）, were significantly associated with improved survival. Conclusions Shortcourse WBRT with 5 ×4 Gy appeared preferable for most NSCLC patients, as it was associated with survival similar to longer WBRT programs, and the short course saves treatment time and spending.