脑转移瘤患者两种放疗分割模式的疗效及放射性脑损伤评估

Evaluate the Treatment Outcomes and Radiation Brain Injury on Two Protocols of Fractionated Radiotherapy in Patients with Brain Metastases

比较A组全脑放疗DT 30Gy/10次/2周后局部推量DT 30Gy/15次/3周及B组全脑放疗DT 40Gy/20次/4周后局部推量DT 20Gy/10次/2周两种放疗分割模式治疗脑转移瘤的疗效,并评估其放射性脑损伤,优化治疗方案。回顾性分析脑转移瘤患者155例,根据放疗分割模式不同,纳入A组79例,B组76例,放疗后行MRI扫描,应用RECIST1.1实体瘤评估标准对放疗后的效果进行评估,采用SOMA对放疗后的毒性反应进行分级。以Wilcoxon秩和检验评估放疗疗效及放疗后的毒性反应。结果显示采用RECIST1.1标准,B组疗效优于A组(Z=-3.036,P<0.05,A组平均秩为88.15,B组平均秩为67.45),SOMA分级显示B组放射性脑损伤轻于A组(主观指标Z=-3.126,P<0.05,A组平均秩为88.67,B组平均秩为66.91;客观指标Z=-2.900,P<0.05,A组平均秩为67.87,B组平均秩为67.74)。全脑放疗DT 40Gy/20次/4周后局部推量DT 20Gy/10次/2周的剂量分割模式既达到治疗效果,又可减轻放射性脑损伤,患者临床获益更大。

To compare group A receiving 30Gy whole brain radiation in 10 fractions over two weeks followed by 30Gy focal radiation in 15 fractions over three weeks and group B receiving 40Gy whole brain radiation in 20 fractions over four weeks followed by 20Gy focal radiation in 10 fractions over two weeks two protocols of fractionated radiotherapy in patients with brain metastases, and to assess their treatment outcomes and radiation brain injury, in order to optimize the treatment regimen. 155 patients with brain metastases were divided into Group A （79 cases） and group B （76 cases） by the different radiation protocoIs, used the RECIST1. 1 solid tumor assessment criteria to assess the effect of radiotherapy on MRI images and used SOMA toxicity after radiotherapy for grading. The authors applied Wilcoxon rank to inspect appraisal radiotherapy curative effect and toxic reaction of radiotherapy after differences between groups. Results showed according to the RECIST1. 1 standards, group A more effective than group B （Z=-3. 036, P〈0.05, the average rank of A group was 88.15, the average rank of B group was 67.45）, SOMA systematics demonstrated the radiation brain injury of group B lighter than group A （Subjective indicators： Z= -3. 126, P〈0. 05, the average rank of A group was 88. 67, the average rank of B group was 66.91; Objective indicators： Z=-2. 900, P〈0.05,the average rank of A group was 67. 87, the average rank of B group was 67.74）. 40Gy whole brain radiation in 20 fractions over four weeks followed by 20Gy focal radiation in 10 fractions over two weeks not only achieve a therapeutic effect, but also reduce the radiation injury, so patients achieve greater clinical benefit, improve the quality of life of patients.