颅内脑转移瘤立体放疗的临床研究

Clinical study of fractionated stereotactic radiotherapy in patients with intracranial metastatic tumors

目的 对比分析X线立体定向分次放射治疗 (fractionatedstereotacticradiotherapy ,FSRT)加全脑放疗与单纯FSRT和单纯全脑放疗对颅内脑转移瘤的疗效及影响。方法 颅内脑转移瘤患者 15 4例 ,中位年龄 5 8 4岁 ,病灶数 316个 ,平均体积 16 5 3mm3 ,6 2例行FSRT加全脑放疗 ,单纯FSRT 32例 ,单纯全脑放疗 6 0例。FSRT等中心剂量 16～ 2 4Gy/1周 ,全脑放疗 30～ 4 0Gy/3～ 4周。单纯全脑放疗 30～ 4 0Gy/3～ 4周后缩野加量 10～ 18Gy/1～ 2周。结果 FSRT加全脑放疗中位生存期 11个月 ,完全缓解 (CR) +部分缓解 (PR) 97 9%。 1年生存率 4 5 % ,2年生存率为 13 3% ,局部复发率 5 %。单纯FSRT ,中位生存期 8个月 ,CR +PR 10 0 % ;1年生存率 2 9% ,2年生存率 9 7% ,局部复发率 6 4 %。全脑放疗中位生存时间 4 5个月 ,CR +PR 6 2 4 % ,1年生存率 8 92 % ,局部复发率 10 7%。FS RT加全脑放疗和FSRT分别与全脑放疗方法疗效比较 ,经统计学处理几项指标差异均有显著性。局控率分别为χ21,3 =32 5 ,P <0 0 0 1,χ22 ,3 =12 13,P <0 0 0 1;1年生存率分别为 χ21,3 =18 87,P <0 0 0 1,χ22 ,3 =5 97,P <0 0 5 ;KPS评分比较分别为 χ2 =8 87,P <0 0 1,χ2 =7 18,P <0 0 1;实体瘤客观疗效评价分别为 χ2

Objective To analyse and compare the therapecutic effects of fractionated stereotactic radiotherapy(FSRT) plus whole brain radiotherapy,FSRT and whole brain radiotherapy alone in the patients with intracranial metastatic tumors.Methods One hundred and fifty four patients with intracranial metastatic tumor;their median age was 58 4.the number of tumors was 316,and the mean tumor volume was 16 53 mm 3.62 cases of the total were treated by FSRT plus whole brain radiotherapy,32 cases by FSRT alone,and 60 cases by whole brain radiotherapy alone.The isodose of FSRT was 16～24 Gy in a week.The dose of whole brain radio therapy was 30～40 Gy in 3～4 weeks at first.then a dosage of 10～28 Gy in 1～2 week was added to the smaller fields.Results The median survival period of FSRT plus whole brain rediotherapy was 11 months,complete remission and partial remission (CR+PR) was 97 9%,1 year survival rate was 45% and the local recrudescence rate was 5%.These data above mentioned for FSRT were 8 months,100%,29% and 6 4% respectively;for whole brain radiotherapy,they were 4 5 months,62 4%,8 92% and 10 7% respectively.2 year survival rate of FSRT plus whole brain radiotherapy was 13 3%,while that of FSRT alone was 9 7%.Having compared the therapeutic effect of whole brain radiotherapy alone with that of FSRT plus whole brain radiotherapy or that of FSRT alone,the author made the data processed by statistics,showing significant differences.To local control rate, χ 2 1,3 =32 5, P <0 001, χ 2 2,3 =12 13, P <0 001;to 1 year survival rate, χ 2 1,3 =18 87, P <0 001, χ 2 2,3 =5 97, P <0 05;to KPS, χ 2 1,3 =8 87, P <0 01, χ 2 2,3 =7 18, P <0 01,to tumor natural therapeutic effect, χ 2=20 23, P <0 001, χ 2=8 65, P <0 01.Conclusion The therapeutic effect of FSRT alone or that of FSRT plus whole brain radiotherapy is better than that of whole brain radiotherapy alone in local control rate,1 year suvival rate,living quality,KPS score,median survival time and tumor natural therapeutic effects,etc.FSRT plus whole brain radiotherapy can prolong the median survival time.