全脑同期加量调强放疗治疗脑转移瘤的临床研究

Clinical study of intensity modulated radiation therapy for whole-brain radiotherapy with simultaneous integrated boost for brain metastases

目的 评价全脑同期加量调强放疗（IMRT）治疗脑转移瘤的疗效及安全性.方法 选择2015年1月至2017年1月在广西壮族自治区玉林市第一、二人民医院住院放疗的120例脑转移瘤患者.采用信封法将患者随机分为三维适形序贯加量组（3 DCRT组,n=60）和调强同步加量组（IMRT组,n=60）,比较两组的疗效及患者放疗前后精神状态变化.结果 3DCRT组患者中位生存期为11.5个月,半年、1年生存率分别为83.3％、35.0％;IMRT组患者中位生存期为12.9个月,半年、1年生存率分别为86.7％ 、38.3％,两组预后差异无统计学意义（χ2=0.143,P=0.705）.3DCRT组完全缓解8例,部分缓解38例,病情稳定11例,疾病进展3例,IMRT组分别为9例、40例、9例和2例,两组近期疗效差异无统计学意义（Z=-0.641,P=0.520）.单因素分析结果显示,递归分隔分析（RPA）分级（χ2=53.484,P＜0.001）、颅外病灶的控制情况（χ2=13.392,P＜0.001）、中线结构是否偏移（χ2=4.427,P=0.035）为预后相关因素.多因素分析结果显示,RPA分级（HR=2.631,95％ CI为1.884 ～3.673,P＜0.001）、颅外病灶的控制情况（HR=1.697,95％ CI为1.034 ～2.786,P=0.037）、中线结构是否偏移（HR=1.787,95％CI为1.118 ～2.856,P=0.015）是影响患者生存率的独立预后因素.3DCRT组放疗前后简短精神状态量表评分分别为（27.12 ±2.42）分、（26.08±2.42）分,差异有统计学意义（t=2.723,P=0.009）;IMRT组放疗前后评分分别为（26.57 ±3.09）分、（27.20±2.46）分,差异无统计学意义（t=-1.610,P =0.113）.结论 全脑同期加量IMRT是多发脑转移瘤的一种有效治疗手段,可缓解患者症状,延长生存期,提高生命质量.

Objective To evaluate the efficacy and safety of intensity modulated radiation therapy （IMRT） for whole-brain radiotherapy with simultaneous integrated boost for brain metastases.Methods From January 2015 to January 2017,120 patients with brain metastases undergoing hospital radiotherapy at the First People＇s Hospital and the Second People＇s Hospital of Yulin City of Guangxi Zhuang Autonomous Region were randomly divided into three dimensional conformal radiation therapy （3DCRT） group （n =60） and IMRT group （n =60） by envelope method.The curative effects of the two groups and the changes of patient＇s mental states before and after radiotherapy were compared.Results The median survival times of patients in 3DCRT group was 11.5 months,and the 6 months and 1 year survival times rates were 83.3% and 35.0% respectively.The median survival times of patients in IMRT group was 12.9 months,and the 6 months and 1 year survival rates were 86.7% and 38.3% respectively.There was no significant difference in prognosis between the two groups （χ2 =0.143,P =0.705）.There were 8 cases with complete remission,38 cases with partial remission,11 cases with stable disease,3 cases with progressive disease in 3DCRT group,and there were 9,40,9,2 cases in IMRT group respectively.There was no statistically significant difference in short-term efficacy between the two groups （Z =-0.641,P =0.520）.Univariate analysis results showed that recursive partitioning analysis （RPA） classification （χ2=53.484,P 〈0.001）,extracranial lesions control （χ2=13.392,P 〈 0.001）,whether the midline offset （χ2 =4.427,P =0.035） were prognostic factors.Multivariate analysis results showed that RPA classification （HR =2.631,95 % CI：1.884-3.673,P 〈 0.001）,extracranial lesions control （HR =1.697,95% CI：1.034-2.786,P =0.037）,whether the midline offset （HR =1.787,95% CI：1.118-2.856,P =0.015） were the independent prognostic factors for the overall survival.According to the results of activities of mini-mental state examination,the scores of 3DCRT group before and after radiotherapy were 27.12 ± 2.42 and 26.08 ± 2.42 respectively,with a significant difference （t =2.723,P =0.009）;and the scores of IMRT group before and after radiotherapy were 26.57 ± 3.09 and 27.20 ± 2.46 respectively,with no significant difference （t =-1.610,P =0.1 13）.Conclusion IMRT for whole-brain radiotherapy with simultaneous integrated boost is an effective treatment for multiple brain metastases,which can relieve symptoms,prolong survival time and improve quality of life.