累及野适形调强放疗用于肺癌患者局限性脑转移瘤的疗效分析

Analysis of therapeutic effects of involved field irradiation for localized brain metastases in patients with lung cancer

目的评估累及野放射治疗(involved field irradiation,IFRT)及立体定向放射外科(stereotactic radiosurgery,SRS)对肺癌局限性(1~3个)脑转移瘤患者的临床疗效。方法回顾性收集山东省肿瘤医院、徐州医学院附属医院2家医疗机构在2013年1月到2018年3月期间收治的接受局部颅脑放疗的肺癌局限性脑转移瘤患者,根据接受颅脑放疗方式的不同分为IFRT组(189例)和SRS组(134例),主要研究终点为颅内无进展生存时间(intracranial progression-free survival,iPFS),次要研究终点为总体生存时间(overall survival,OS)。结果本研究共纳入323例1~3个脑转移瘤的肺癌患者,男性患者210(65.0%)例;女性患者113(35.0%)例。在整体队列(n=323,11.5个月∶9.5个月,HR=1.09,95%CI:0.84~1.42,P=0.518)和匹配队列(n=242,9.7个月∶9.6个月,HR=1.05,95%CI:0.78~1.41,P=0.753)中,IFRT、SRS两组之间的中位iPFS均无统计学意义。在整体队列(n=323)中两组患者的中位OS显著延长(21.9个月∶14.5个月,HR=1.41,95%CI:1.03~1.93,P=0.033);在匹配队列(n=242)中,两组患者的中位OS之间无统计学意义(20.5个月∶14.5个月,HR=0.82,95%CI:0.58~1.17,P=0.275)。结论相比于SRS,IFRT并未减少生存获益,可以作为局限性肺癌脑转移瘤的替代治疗方案。

Objective To evaluate the efficacy of involved field irradiation(IFRT)and stereotactic radiosurgery(SRS)for limited(1~3)brain metastases in lung cancer patients.Method Patients with lung cancer who received local radiotherapy for limited brain metastases at two medical institutions between January 2013 and March 2018 were retrospectively screened.According to the accepted brain radiotherapy,patients were divided into two groups:IFRT group(n=189),SRS group(n=134).The primary endpoint of this study was intracranial progression-free survival(iPFS),and secondary endpoint was overall survival(OS).Result This study were included 323 lung cancer patients with 1~3 brain metastases,among of them,210(65.0%)were male,113(35.0%)were female.There were no significant difference in median iPFS between IFRT and SRS groups both in the entire cohort(n=323,11.5 months∶9.5 months,HR=1.09,95%CI:0.84~1.42,P=0.518)and matched cohort(n=242,9.7 months∶9.6 months,HR=1.05,95%CI:0.78~1.41,P=0.753).In the entire cohort(n=323),IFRT group showed significant OS benefit than SRS group(21.9 months∶14.5 months,HR=1.41,95%CI:1.03~1.93,P=0.033).In the matched cohort(n=242),there was no significant difference in median OS between IFRT and SRS groups(20.5 months∶14.5 months,HR=0.82,95%CI:0.58~1.17,P=0.275).Conclusion Compared to SRS,IFRT did not reduce survival benefit and may be used as an alternative treatment for limited brain metastases in lung cancer patients.