肺癌脑转移瘤放疗后患者认知功能损害的临床研究

Clinical study of cognitive lmpairment in patients with brain metastases from lung cancer after radiation therapy

目的对比分析多次伽玛刀治疗及全脑放疗结合伽玛刀治疗肺癌脑转移瘤的疗效并评价两种治疗方式对患者认知功能及生存质量的影响。方法分别采用MMSE、KPS评分判断患者的认知功能及生活质量;采用WHO的疗效评价标准进行肿瘤局部控制率的评价;Kaplan-Meier法描述生存过程,log-rank法比较多次伽玛刀治疗组和全脑放疗结合伽玛刀治疗组的生存曲线是否有差异。结果两组MMES得分变化趋势明显不同,经F检验,P=0.001<0.05,多次伽玛刀治疗组治疗后不同时间点与基线对比差异无统计学意义,且各时间点间差异均无统计学意义;而全脑放疗结合伽玛刀治疗组治疗后不同时间点与基线对比差异有统计学意义,且各时间点间差异均有统计学意义,呈显著下降趋势。全脑放疗结合伽玛刀治疗组治疗结束后3个月、6个月、9个月的MMSE评分与多次伽玛刀治疗组相比均明显下降,经t检验P<0.05,差异有统计学意义。所有接受伽玛刀治疗患者的KPS评分治疗后2周与治疗前1周相比,经χ~2检验P<0.05,差异有统计学意义。两种治疗方法的近期肿瘤局部控制率、中位生存期相比差异无统计学意义。结论多次伽玛刀治疗肺癌脑转移瘤有较好的肿瘤控制率及生存期,同时有效保护患者的认知功能,提高患者生活质量。所以,伽玛刀治疗对肺癌脑转移瘤患者是一种良好的治疗选择。

Objective The study is to analyze the efficacy of patients with brain metastases from lung cancer by comparing the way of multiple gamma knife and whole brain radiotherapy plus gamma knife,and is to assess the effect of two treatments on cognitive function and quality of life.Methods KPS and MMSE assessments to evaluate the patient＇s cognitive function and quality of life.The WHO therapeutic effect evaluation criteria was used to evaluate the local tumor control rate.Kaplan-Meier method was used to describe the survival process.The log-rank test was used to compare differences in the survival curve between multiple gamma knife and whole brain radiotherapy plus gamma knife.Results The MMSE scores of the two groups were significantly different,by F test P=0.0010.05.Compared with baseline MMSE score,the multiple gamma knife group had no difference in different time points after therapy,and there was no difference in times.Compared with baseline MMSE score,the whole brain radiotherapy plus gamma knife group had significant difference in different time points after therapy,and there was significant decreased in times.Compared with the multiple gamma knife group MMSE score,the whole brain radiotherapy plus gamma knife group had a significant decline in 3 months,6 months and 9 months after therapy,there was significant difference by t test P〈0.05.Compared with 1 week before therapy,KPS scores of all patients receiving gamma knife had significant difference in2 weeks after therapy,by the chi-square test P〈0.05.The two treatments had no difference in recent local tumor control rate and the median survival time.Conclusion Multiple gamma knife radiosurgery in patients with brain metastases from lung cancer have a better local tumor control rate and survival time,and can effectively protect the patient＇s cognitive function,improve the patient＇s quality of life.So gamma knife radiosurgery in patients with brain metastases from lung cancer is a good treatment option.