152例肺癌脑转移立体定向放疗预后分析

Stereotactic Radiotherapy for Brain metastases from 152 lung cancer patients

目的分析肺癌脑转移的立体定向放疗（SRT）疗效和预后因素。方法回顾分析行SRT的152例肺癌脑转移病例。单纯SRT组59例，SRT加全脑放疗（WBRT）组40例，WBRT失败后SRT挽救组53例。Logrank法单因素分析，Cox模型多因素分析。结果全组随访率为97．4％。单纯SRT组，SRT加WBRT组和SRT挽救组6个月、1年局部控制率分别为96．0％、93．4％，94．2％、90．8％和81．7％、77．5％（x。=5．39，P=0．068），1、2、5年生存率分别为47．4％、23．7％、8．5％，55．0％、20．0％、0％和41．5％、7．5％、1．9％（）（2=4．08，P=0．130）。单因素分析显示诊断肺癌到脑转移时间、卡氏评分、肺癌切除、GPA分级、RPA分级、颅外病变是影响生存的因素（x。=11．97、5．91、15．48、14．48、15．86、17．36，P=0．001、0．015、0．000、0．000、0．000、0．000）。多因素分析显示RPA分级、肺癌切除与总生存有关（X^2=21．02、8．18，P=0．000、0．004）。全组患者SRT前和后3个月卡氏评分≤70、80、90的比例分另0为48．7％、35．6％、17．8％和27．0％、46．7％、26．3％（t=7．16，P=0．000）。结论SRT对肺癌脑转移有较好疗效且单纯SRT、SRT加WBRT和SRT挽救治疗结果相似；RPA分级、肺癌切除是影响生存因素；SRT可改善患者卡氏评分。

Objective To assess the clinical efficacy and prognostic factors of Stereotactic Radiotherapy （SRT） for patients with brain metastases （BM） from lung cancer. Methods From March 1995 to July 2006, 152 consecutive patients with BM from lung cancer were treated by SRT, among them, 59 patients received SRT alone, 40 patients received SRT plus whole brain radiotherapy （ SRT ＋ WBRT）, and 53 patients were salvaged by SRT after WBRT （salvaged group）. Log-rank method was used for univariate analyses. Cox regression model was used for multivariate analyses. Results The follow-up rate was 97.4%. The half year and 1 year local control rate for SRT alone group, SRT ＋ WBRT group and salvage group were 96.0% and 93.4% ,94. 2% and 90. 8%, 81.7% and 77.5% （ ~2 = 5.39, P = O. 068） respectively. The 1-,2-,5 year survival rate for SRT alone group, SRT ＋ WBRT group and salvage group were 47.4%, 23.7%, 8.5% ; 55.0%, 20. 0%, 0% ; 41.5%, 7.5%, 1.9%, respectively. The median overall survival for each group was 11,12, 11 months （ X2 = 4. 08, P = 0. 130）. The univariate analysis showed that the interval between diagnosis of lung cancer and BM, KPS, thoracic surgery, GPA grade, RPA class, system disease stable were significant prognostic factors （~2 = 11.97, 5.91, 15.48, 14. 48, 15.86, 17.36, P =0. 001,0. 015, 0. 000, 0. 000, 0. 000, 0. 000）. The multivariate analysis showed that the RPA class, thoracic surgery were the independent prognostic factors （ X2 = 21.02,8. 18, P = 0. 000,0. 004）. KPS score less than 70, 80,90 for all patients before SRT and 3 months later after SRT were 48.7%, 33.6%, 17.8% and 27.0%, 46.7%, 26. 3% respectively （ t = 7.16, P = 0. 000 ）. Conclusions A definitive benefit of SRT in the treatment BM from lung cancer is observed; there is no difference of survival among SRT alone, SRT ＋ WBRT and salvage treatment. SRT can improve the patients＇ KPS score. Thoracic surgery, RPA class were the independent prognostic factors for patients with BM from lung cancer.