X-刀治疗脑转移瘤45例临床分析

Linac stereotatic radiosurgery for brain metastasis: analysis of 45 patients

采用Ｘ－刀治疗脑转移瘤４５例。经６～２４个月随访，中位生存期为８个月，半年局控率为８４．４％。生存率与放疗前ＫＰＳ评分级别、有无其它部位转移、是否行全脑照射有关。放疗３个月头颅ＣＴ、ＭＲＩ复查显示肿瘤控制，有效率８１％（２９／３６），且转移瘤体积≤７ｃｍ３与＞７ｃｍ３比较有效率明显提高（Ｐ＜０．０１）。脑转移瘤是否辅以全脑照射应视病理及病情而定；对大病灶（直径＞３．５ｃｍ）可采用分次Ｘ－刀治疗，以减少并发症发生率。

5 patients of brain metastasis were treated with linac stereotatic radiosurgery. All the patients have been followed-up 6 to 24 months. Median survival time was 8 months. The 6-month tumour control rate was 84.4%. The date showed that three factors influence the survival: they are KPS score, extracranial metastasis when the patient presented for SRS treatment and whole brain radiotherapy. The 3 month tumor control rate evatuated by CT, MRI was 81%. The tumor control rate of the tumors whose tumors volumes were less than 7cm3 was significantly higher than that of tumors volumes more than 7cm3(P<0.01). Whether or not the whole brain radiotherapy should be given, it depend on the pathological diagnosis and the general condition of the patient. The large brain metastatiec lesions(>3.5cm in maximum diameter) should be treated with fractionation linac radiosurgery in order to decraese the side effects and the late complications.