单发脑转移瘤患者行立体定向放疗或转移瘤切除术后全脑放疗的疗效比较

Stereotactic radiosurgery alone versus resection plus whole-Brain radiotherapy for single brain metastasis patients

目的本研究拟探讨在单发脑转移瘤患者中，单独应用立体定向放射治疗（SRT）和转移瘤切除术后补充全脑放疗（WBRT）的效果对比。方法回顾性分析72例患者入组，A组即单独应用立体定向放射治疗组，38例，SRT治疗根据肿瘤靶区大小，单次剂量3～12Gy，总剂量30～40Gy；B组为手术加术后全脑放疗组，34例，脑转移癌孤立病灶全部切除，术后行全脑放疗（WBRT）：2Gy／次，总共20次，给予剂量40Gy／4w。观察终点为生存期，评估两组间病人效果差别。结果两组病人在生存时间未见明显差别（均P〉0．05），进一步分析发现病人生存时间均与年龄，KPS评分，是否存在脑外其他部位转移等变量存在明显相关性，均P〈0．05，其中年龄≤60岁者均好于年龄大于60岁者，KPS评分为90或100分者明显好于70或者80分者，未有脑外其他部位转移者好于存在脑外其他部位转移者。而脑瘤控制情况与上述因素均未见明显相关（均P〉0．05）。结论单发脑转移瘤患者行立体定向放疗与转移瘤切除术后全脑放疗的患者生存时间和脑转移瘤控制情况均无明显差别，患者的生存时问主要与年龄，KPS评分，是否存在脑外其他部位转移等情况有关。

Aim To compare stereotactic radiosurgery（SRS） alone with resection plus whole -brain radiotherapy（WBRT） for the treatment of patients who had single brain metastasis. Methods Data of 72 patients who had brain metastasis are analyzed retrospectively. Patients in group A（ n = 38） received from 30 grays （Gy） to 40 Gy SRS, and patients in group B （n = 34） underwent resection of their metastasis and received 40Gy/4 weeks WBRT. Overall survival（OS） and brain control（BC） were analyzed. Results On multivariate analysis, improved OS was associated with age ≤60 years, better performance status （KPS） , no extracranial metastases, but has no association with sex,treatment group and primary tumor. Brain control（BC） has no association with age, sex, KPS status and treatment group. Conclusions SRS alone appeared to be as effective as resection plus WBRT in the treatment of brain metastasis patients. Patient overall survival（OS） was associated with age,karnofsky performance status.