56例非小细胞肺癌脑转移行全脑调强放疗的疗效和预后因素分析

Clinical Efficacy of Whole Brain Radiation with IMRT Boost for Non-Small Cell Lung Cancer with Brain Metastases and the Prognostic Analysis(56 Cases)

目的评价全脑调强放射治疗非小细胞肺癌脑转移的疗效以及影响患者生存率的预后因素。方法回顾性分析2008年3月至2011年12月在湖北省肿瘤医院放疗中心行全脑调强放射治疗的56例非小细胞肺癌脑转移患者的临床资料。采用Kaplan—Meier法进行生存分析，采用Log—rank检验行单因素生存相关危险因素分析，采用Cox回归模型进行影响患者预后的多因素分析。结果56例患者的中位生存期为10．5月。6个月、1年和2年生存率分别为78．6％、44．6％和19．6％。多因素分析结果显示治疗前年龄、KPS评分、RPA分级、颅外病灶控制情况、最大脑转移灶体积、全脑放射治疗时／后是否接受生物靶向治疗是影响患者生存率的独立预后因素。无Ⅲ～Ⅳ级血液学以外的不良反应。结论全脑调强放射治疗是非小细胞肺癌多发脑转移瘤的一种有效治疗手段，可有效缓解患者症状，延长生存期，提高生活质量。

Objective To evaluate the clinical efficacy of whole brain radiation with intensity modulated radiation therapy （IMRT） boost in the treatment of non-small cell lung caner （NSCLC） patients with brain metastases and the influencing factors of the prognosis of these patients. Methods The clinical data of 56 NSCLC patients with brain metastases who received whole brain radiation followed by IMRT boost from March 2008 to December 2011 in Hubei Cancer Hospital were retrospectively ana- lyzed. The overall survival was estimated by Kaplan-Meier analysis. The univariate analysis of the survival-related risk factors was performed by Log-rank test. The potential prognostic factors related to survival were evaluated by the Cox regression analysis. Results The median survival time was 10.5 months for all patients. The 6-month, 1-year and 2-year overall survival rate were 78.6% ,44.6% and 19.6%, respectively. Multivariate analysis showed that age, KPS score, RPA grade, control of extracranial lesion, volume of the largest metastasis, and target therapy during or after whole brain radiation were independent pre- dictive factors of survival. No severe adverse events and toxicity except grade Ⅲ --Ⅳ hematological toxicity were ob- served. Conclusion Whole brain radiation with IMRT boost is an effective treatment that can relieve symptoms of NSCLC patients with brain metastases, prolong survival time and improve the quality of life of the patients.