大分割立体定向放射治疗NSCLC脑转移的临床观察

Effects and prognostic factors of hypofractionated stereotactic radiotherapy for brain metastasis in non-small cell lung cancer

目的:分析大分割立体定向放射治疗(HSRT)非小细胞肺癌(NSCLC)脑转移的有效性及预后因素。方法:选取60例有124个脑转移病灶的NSCLC患者进行HSRT,其中90个病变进行全脑放射治疗加HSRT,34个病变初始进行HSRT,中位随访12个月。观察近期疗效及预后因素。结果:全脑放疗加HSRT组46个病变完全缓解(CR),28个部分缓解(PR),9个病变稳定(SD),7个病变进展(PD);6、12个月的局部控制率和总生存率分别为92.3%、66.9%和73.2%、47.6%。单独HSRT组20个病变CR,7个PR,4个SD,3个PD;6、12个月的局部控制率和总生存率分别为92.7%、65.9%和70.2%、45.8%。多因素分析结果显示,脑转移个数(OR=1.675,P=0.001)、颅外有无转移性病灶(OR=1.934,P=0.036)和原发灶控制(OR=7.936,P=0.033)是影响患者生存率的独立预后因素。结论:HSRT是治疗NSCLC脑转移有效方法之一。脑转移个数、颅外有无转移性病灶和原发灶控制是影响患者预后的独立因素。

OBJECTIVE： To study the effects and prognostic factors for patients with brain metastases in nonsmall cell lung cancer （NSCLC） treated by hypofractionated stereotactic radiotherapy （HSRT）. ME1HODS： A total of 60 patients with brain metastasis were recruited, which included 124 metastatic lesions. All patients received the treatment of HSRT. Ninety metastasis le sions received the HSRT plus whole brain radiotherapy, and thirtyfour lesions received the HSRT alone. Median follow up time was 12 months. The effective rate and prognostic factors were observed and analyzed accordingly. RESULTS.. In group of receiving HSRT with whole brain radiotherapy, forty-six of metastasis lesions were reached to complete remission （CR）, 28 to partial remision （PR）, 9 to stable disease（SD）, and 7 to progressive disease（PD）. Localcontrol （LC） rate at 6-and 12-month was 92. 3% and 66. 9 %, and the overall survival （OS） rate was 73. 2% and 47. 6%, respectively. In group of receiving HSRT alone, twenty of metastasis lesions were reached for CR, 7 for PR, 4 for SD, and 3 for PD. LC rate at 6- and 12- month was 92. 7% and 65. 9% and the OS rate was 70.2% and 45.8%, respectively. Multivariate analysis showed that the amount of the metastasis lesions （OR=1. 675, P=0. 001）, extracranial metastasis （OR= 1. 934, P=0. 036） and the control of the primary tumor （OR= 7. 936, P=0. 033） were the independent factors for the OS. CONCLUSIONS： HSRT is one of the efficacious methods for the treatment in NSCLC patients with brain metastases. Numbers of brain metastasis lesions, extracranial metastasis and eontrolled primary lesion are independent prognostic factors.