伽玛刀联合全脑放疗治疗脑转移癌近期疗效观察

Short-term outcomes of gamma knife stereotactic radiotherapy combined with whole brain irradiation on brain metastases

目的评价伽玛刀联合全脑放疗治疗脑转移癌的近期临床疗效。方法所有33例患者首先经全脑放疗,2-3Gy/次,5次/周,DT30～40Gy后复查头颅MRI,病灶直径小于3cm采用单次伽玛刀治疗,大于3cm采用分次伽玛刀治疗,50%～70%等剂量曲线覆盖整个靶区,单次伽玛刀治疗剂量为12～18Gy,分次伽玛刀单次周边剂量给予3～5Gy,周边总剂量18～24Gy,分割4～6次,每周3～5次。结果治疗结束后1个月复查脑部MRI或CT,完全缓解12例(36.4%),部分缓解19例(57.6%),有神经系统症状22例患者,神经症状完全缓解7例(31.8%),部分缓解14例(63.6%),所有患者KPS评分均有上升。随访至今,有12例死亡,中位生存期10.7个月。结论伽玛刀联合全脑放疗治疗脑转移癌不仅能控制脑转移病灶、提高生活质量,而且能延长患者生存期。

Objective To evaluate the short-term outcomes of gamma knife stereotactic radiotherapy combined with whole brain irradiation for patients with brain metastasis.Methods 33 cases with brain metastasis were treated by gamma knife stereotactic radiotherapy combined with whole brain irradiation.the patients were reexamined by cranial MRI after whole brain irradiation,if the diameter of the tumor≤3cm we used gamma knife radiosurgery once,if the diameter of the tumor3cm,we used gamma knife stereotactic radiotherapy fractionation.The radiosurgery plan was designed to cover whole target area at isodose curves of 50%~70% with a margin dose of 12-16 Gy once or the margin dose of 4-6 Gy each time,the total margin dose of 18~24 Gy,which was carried out at a frequency of 3-5 times each week.Results Within 1 month after radiotherapy,according to CT or MRI of the brain,the CR of all patients was 12例（36.4%）,PR 19例（57.6%）.For the 22cases with neural symptoms before radiation,the CR of the symptoms was 31.8% and PR 63.6%.All patients gained different increases in KPS grade.By the end of the follow-up period,there were 12 deaths with the mean survival time up to 10.7 months.Conclusion Gamma knife stereotactic radiotherapy combined with whole brain irradiation for patients with brain metastasis can not only effectively control brain metastases and improve life quality,but also tends to prolong survival time.