立体定向放疗挽救治疗全脑放疗后颅内失败的脑转移瘤患者的临床观察

Clinical Observation of Stereotactic Radiosurgery for Brain Metastases afer Failure of Whole Brain Radiation Therapy

目的观察立体定向放疗（SRS）治疗全脑放疗后颅内失败的脑转移瘤的颅内无进展生存时间、总生存时间、预后影响因素以及不良反应，探讨SRS对全脑放疗后颅内失败的脑转移瘤的挽救治疗作用。方法2007年9月～2011年4月笔者医院收治的51例全脑放疗后颅内失败的脑转移瘤患者接受颅脑挽救性SRS。结果全组患者近期有效率为80．4％，中位颅内无进展生存时间7．4个月，1、2年的颅内无进展生存率41．2％、19．6％，ffl位生存时间9．1个月，1、2年生存率分别是25．5％、15．7％。单因素分析显示：KPS评分、RPA分级、总靶体积为疾病进展时间预测因素（P均〈0．05）；而KPS评分、RPA分级、原发病、总靶体积、颅外病变情况、WBRT治疗后与SRT治疗间隔时间是生存时间预测因素（P均〈0．05）。

Objective To investigate time to local failure(TTF),overall survival(OS) and toxicity of stereotactic radiosurgery(SRS) for brain metastases(BM) after failure of whole brain radiation therapy(WBRT).Methods From September 2007 to April 2011,totally 51 patients with BM after failure of WBRT were treated with SRS.Results The objective response rate was 80.4%.The median TTF was 7.4 months,whereas the median OS was 9.1 months.The 1-year,2-year TTF and OS rates were 41.2%,19.6% and 25.5%,15.7%.Univariate analysis showed that the KPS score,RPA class and total target volume were predictive factors for TTF(P < 0.05).The KPS score,RPA class,total target volume,RPA class,the status of extracranial metastases and Interval from the end of WBRT to SRS were predictive factors for OS of the patients(P < 0.05).Multivariate analysis showed that RPA class was prognosis factor for TTF(P < 0.05) and total target volume and KPS score were prognosis factor for OS.The central nervous system toxicity was milder and all were well-tolerated.Conclusion SRS was effective and safe for patients with BM after failure of WBRT.This therapy can improve the clinical median time to LF and OS of the disease.