调强同步推量放射治疗脑多发转移瘤疗效观察

Effect of simultaneous integrated boost intensity-modulated radiation therapy in the treatment of multiple metastasis tumor of brain

目的探讨调强同步推量放射治疗和全脑放射治疗+适形放射序贯推量治疗在脑多发转移瘤患者中的临床效果。方法将新乡医学院第一附属医院放射治疗中心2014年8月至2015年7月收治的脑多发转移瘤患者98例根据治疗方案分为观察组60例和对照组38例。观察组患者实施调强同步推量治疗,全脑计划靶区剂量为每次2 Gy,转移灶计划靶区剂量为每次3 Gy,共20次,每周5次。对照组患者实施全脑放射治疗+适形放射序贯推量治疗,全脑放射治疗剂量为每次3 Gy,共10次,每周5次,然后各转移灶推量,计划转移瘤靶区剂量为3 Gy,共10次。全部患者在治疗结束后进行随访,随访时间截至2016年12月。比较2组患者的有效率、疾病控制率及1 a生存率。结果2组患者均顺利完成放射治疗。90例患者获得随访,8例失访,随访率为91.8%(90/98)。观察组患者的有效率、疾病控制率、1 a生存率均显著高于对照组(χ~2=5.371、4.352、6.002,P<0.05)。观察组患者的中位无进展生存时间显著长于对照组(χ~2=6.537,P<0.05)。2组患者骨髓抑制、消化系统反应、神经系统损伤发生率比较差异均无统计学意义(χ~2=1.821、2.032、3.782,P>0.05)。结论调强同步推量放射治疗可以更好地提高脑多发转移瘤患者的有效率、疾病控制率和1 a生存率。

Objective To investigate the clinical effect of simultaneous integrated boost intensity-modulated radiation therapy（ SIB-IMRT） and whole brain radiation therapy（ WBRT） plus sequential boost conformal radiation therapy（ SBCRT）in the treatment of multiple metastasis tumor of brain. Methods A total of 98 patients with multiple metastasis tumor of brain in the Radiation Oncology Center of the First Affiliated Hospital of Xinxiang Medical University from August 2014 to July 2015 were divided into observation group（ n = 60） and control group（ n = 38） according to the treatment plan. The patients in the observation group were treated with SIB-IMRT,the whole brain planned target dose was 2 Gy every time,and the target dose of the metastatic target volume was 3 Gy every time for 20 times（ 5 times weekly）. The patients in the control group received WBRT plus SBCRT,the WBRT dose was 3 Gy every time for 10 times（ 5 times weekly）,then the metastatic tumor target area was treated with SBCRT,the prescribed dose was 3 Gy every time for 10 times. All patients were followed up from the end of treatment to December 2016. The effective rate,disease control rate and one-year survival rate were compared between the two groups. Results The patients in the two groups were successfully treated with radiotherapy. Ninety patients were followed up,eight patients were lost to follow-up,the follow-up rate was 91. 8%（ 90/98）. The effective rate,disease control rate and oneyear survival rate in the observation group were significantly higher than those in the control group（ χ^2= 5. 371,4. 352,6. 002;P〈 0. 05）. The median progression free survival time in the observation group was significantly longer than that in the control group（ χ^2= 6. 537,P〈 0. 05）. There were no significant differences in the incidence of bone marrow suppression,digestive system reaction and nervous system damage between the two groups（ χ^2= 1. 821,2. 032,3. 782; P〉 0. 05）. Conclusion SIBIMRT can improve the effective rate,disease control rate and one-year survival rate of patients with multiple metastasis tumor of brain.