立体定向放射手术结合全脑照射治疗脑转移瘤

STEREOTACTIC RADIOSURGERY COMBINED WITH WHOLE BRAIN RADIOTHERAPY FOR BRAIN METASTASES

目的探讨立体定向放射手术（ＳＲＳ）结合全脑照射治疗脑转移瘤的疗效和影响预后的因素。方法回顾性分析了１９９４年７月～１９９６年６月间应用ＳＲＳ治疗脑转移患者１８例（２８个病灶）。中位随诊时间为１４个月。所有患者的Ｋａｒｎｏｆｓｋｙ评分≥４０分。肿瘤直径为１２ｍｍ～４０ｍｍ（平均２７ｍｍ）。ＳＲＳ治疗采用１０ＭＶ的直线加速器，肿瘤剂量（８０％剂量线）为２０Ｇｙ～３０Ｇｙ（平均２２１Ｇｙ）。ＳＲＳ后１５例进行了全脑分次照射，脑中间平均剂量为３０Ｇｙ～４０Ｇｙ，ＳＲＳ前后均行ＣＴ和（或）磁共振成像（ＭＲＩ）检查。结果中位生存期为８个月，肿瘤控制率为８３３％（２０／２４），肿瘤消失为５０％（１２／２４），肿瘤明显缩小（＞５０％）为３３３％（８／２４），肿瘤稍缩小（≤５０％）或无变化１６７％（４／２４），ＣＴ显示肿瘤坏死２例，无肿瘤复发。原发肿瘤已控制、无脑外转移患者的生存期较长（Ｐ＜００５），单发和多发脑转移者生存期无明显差异（Ｐ＞００５）。结论ＳＲＳ结合全脑照射治疗脑转移瘤是安全和有效的。

PURPOSE To evaluate the effectiveness of stereotactic radiosurgery (SRS) combined with fractionated whole brain radiotherapy for brain metastases and to discuss the prognosis of such patients.METHODS Retrospective analysis of 18 patients(28 lesions ) with brain metastases who underwent SRS between July 1994 and June 1996. The median followup was 14 months following SRS. The patients' Karnofsky performance scoreis more than 40. Tumor diameter varied from 12 mm～40 mm (mean 27 mm).Treatment was carried out using a 10 MV linear accelerator. Tumor dose(80% reference isodose)varied from 20 Gy～30 Gy (mean 22.1 Gy). Fractionated whole brain radiotherapy (midbrain dose 30 Gy～40 Gy)was given to 15 patients after SRS. Patients were followed by CT and (or) MRI.RESULTS Median survival from SRS is 8 months (range 1～18 months). Tumor control rate is 83.3%(18/24). Tumor complete response rate is 50%(12/24); marked shrinkage (>50%)in lesion size is 33.3%(8/24);slight shrinkage (≤50%)or no change in size of the lesions 16.7%(4/24);documented necrosis in 2 patients. No tumor recurrences. Absence of active systemic disease was associated with increased survival (P<005). When single metastasis was compared to multiple metastases, there was no significant difference in survival(P>005)CONCLUSIONS The results of this retrospective analysis show that SRS combined with whole brain radiotherapy is an effective and safe treatment option.