非小细胞肺癌脑转移患者两种放疗分割模式及疗效评估

Treatment Outcomes of Two Radiation Therapy Protocols in Non-small Cell Lung Cancer Patients with Brain Metastases

目的比较非小细胞肺癌(NSCLC)脑转移患者两种放疗分割模式,分析WHO、RECIST1.0、RECIST1.1标准评价放疗疗效的一致性。资料与方法 83例NSCLC脑转移放疗患者以不同放疗分割模式分为A组(39例)和B组(44例),A组患者全脑放疗DT30Gy/10次/2周后局部推量DT30Gy/15次/3周;B组患者全脑放疗DT40Gy/20次/4周后局部推量DT20Gy/10次/2周。比较两组放疗后疗效和急性毒性反应,分析WHO、RECIST1.0、RECIST1.1标准评估患者放疗疗效的一致性。结果采用RECIST1.1标准,B组疗效优于A组(Z=-3.597,P<0.01);A组放疗后3例发生放射性脑损伤,3例出现神经症状,20例出现头部一般症状;B组18例出现头部一般症状。WHO标准与RECIST1.0、RECIST1.1标准(Kappa=0.945、0.945,P<0.05)、RECIST1.0标准与RECIST1.1标准(Kappa=1,P<0.05)评估NSCLC脑转移放疗疗效的一致性较好。结论 NSCLC脑转移患者全脑放疗DT40Gy/20次/4周后局部推量DT20Gy/10次/2周的治疗方案近期疗效较好,急性毒性反应较少;WHO、RECIST1.0和RECIST1.1标准评价NSCLC脑转移患者放疗疗效一致性较好。

Purpose To compare two radiation therapy protocols in non-small cell lung cancer （NSCLC） patients with brain metastases, and to analyze the consistency of WHO, RECIST 1.0 and RECIST 1.1 response evaluation criteria. Materials and Methods Eighty-three NSCLC patients with brain metastases were randomly divided into group A （n=39） and group B （n= 44）. Group A received 30 Gy whole brain radiation in 10 fractions over two weeks followed by 30 Gy focal radiation in 15 fractions over three weeks. Group B received 40 Gy whole brain radiation in 20 fractions over four weeks followed by 20 Gy focal radiation in 10 fractions over two weeks. Treatment response and acute toxic effects were evaluated. The consistency of WHO, RECIST 1.0 and RECIST 1.1 criteria were analyzed. Results Using RECIST 1.1 treatment response evaluation criteria, group B responded better than group A （Z=-3.597, P＆lt;0.01）. In group A there were 3 cases of acute radiation brain injury, 3 patients presenting with neurologic symptoms and 20 cases with general discomfort. In group B there were 18 cases with general discomfort. There was good consistency between WHO and RECIST 1.0 （Kappa=0.945, P＆lt;0.05）, WHO and RECIST 1.1 （Kappa=0.945, P＆lt;0.05） as well as RECIST 1.0 and RECIST 1.1 criteria （Kappa=1, P＆lt;0.05）. Conclusion NSCLC patients with brain metastases respond well to 40 Gy whole brain radiation in 20 fractions over four weeks followed by 20 Gy focal radiation in 10 fractions over two weeks with lower incidence of acute toxic effects. WHO, RECIST 1.0 and RECIST 1.1 criteria are consistent in evaluating treatment response.