伽玛刀剂量分割治疗肺癌脑转移瘤的疗效及预后分析

Fractionated stereotactic radiosurgery in treatment of brain metastases of lung cancer： a therapeutic effect and prognosis study

目的探讨伽玛刀剂量分割治疗直径为3～7cm的肺癌脑转移瘤的疗效及预后。方法选择内蒙古医科大学附属医院头部伽玛刀治疗中心自2010年4月至2016年11月经伽玛刀治疗的肺癌脑转移瘤（直径为3～7cm）患者80例，其中行单次伽玛刀治疗46例（单次治疗组），行伽玛刀剂量分割治疗34例（剂量分割治疗组）。治疗后3个月比较2组患者肿瘤控制情况、瘤周水肿分级、并发症发生率和Kamofsky功能状态评分（KPS）；多因素Cox回归模型分析影响患者近期疗效的因素：采用Kaplan-Meier法进行生存分析评价患者的预后。结果与单次治疗组比较，剂量分割治疗组患者肿瘤无进展者比例增高，并发症发生率降低，瘤周水肿分级增加者比例降低，KPS评分升高者比例增加，差异均有统计学意义（P〈0．05）。多因素Cox回归模型分析肿瘤直径是影响患者近期疗效的危险因素（P〈0．05）。单次治疗组患者中位生存时间为13．6个月，剂量分割治疗组患者中位生存时间为16个月。与单次治疗组比较，剂量分割治疗组患者半年、1年生存率增高，差异均有统计学意义（P〈0．05）。2组患者2年生存率、累积生存率比较差异无统计学意义（P〉0．05）。结论与单次伽玛刀治疗相比．伽玛刀剂量分割在治疗直径为3～7cm的肺癌脑转移瘤方面更具优势。

Objective To compare the efficacies and prognoses ofstereotactic radiosurgery and fractionated stereotactic radiosurgery in treatment of brain metastases of lung cancer with diameter of 3-7 cm. Methods A retrospective study of 80 patients with brain metastases from lung cancer with diameter of 3-7 cm treated with gamma knife in our hospital from April 2010 to November 2016 was performed. There were 46 patients in stereotactic radiosurgery group and 34 in fractionated stereotactic radiosurgery group. The local aunor rate, incidence of complications, changes of peritumoral edema, and Karnofsky Performance Status （KPS） scale scores at 3 months after operation were compared between the two groups. Multi-factor Cox regression model was used to analyze the factors influencing the short-term efficacy of patients. Kaplan-Meier survival analysis was used to evaluate the survival rate of patients. Results Three months after operation, the local tumor control rate and incidence of complications were 73.9% and 21.7% in the stereotactic radiosurgery group, and 94.1% and 2.94% in the fractionated stereotactic radiosurgery group, with significant differences （P〈0.05）. As compared with those in the stereotactic radiosurgery group, the percentage of patients with increased grading of peritumoral edema was significantly decreased and percentage of patients with increased KPS scores was significantly increased in fractionated stereotactic radiosurgery group （P〈0.05）. Multivariate Cox analysis showed that tumor diameter was the only statistically significant risk factor for prognosis （P〈0.05）. The median survival time was 13.6 months in the stereotactic radiosurgery group and 16 months in the fractionatedstereotactic radiosurgery group. The one-year survival rate and accumulate survival rate showed no significant differences between the two groups （P〉0.05）. Conclusion As compared with stereotactic radiosurgery therapy, fractionated stereotactic radiosurgery has more advantages in the treatment of lung cancer brain metastases with diameter of 3-7 cm.