肺癌脑转移瘤同期加量调强放疗与序贯加量放疗的对比研究

Comparison of Concurrent Intensity-Modulated Radiotherapy and Sequential Intensity-Modulated Radiotherapy for Brain Metastases from Lung Cancer

[目的]比较肺癌脑转移瘤同期加量调强放疗与序贯加量放疗的疗效及不良反应。[方法]选择2018年1月至2019年7月收治的肺癌脑转移患者44例作为研究对象,随机分为同期加量调强放疗组(SIB-IMRT)23例和适形序贯加量放疗组(WBRT+3D-CRT)21例,SIB-IMRT组全脑5-7野IMRT(40Gy/20f)+瘤床SIB(50Gy/20f);WBRT+3DCRT组首先WBRT (40Gy/20f),紧接着缩野至瘤床P-GTV(18.4Gy/8f)。比较两组患者临床疗效、急性不良反应及住院治疗时间。[结果]客观缓解率在SIB-IMRT组和WBRT+3D-CRT组分别为82.6%和52.4%(P=0.03)。SIB-IMRT组和WBRT+3D-CRT组疾病控制率分别为91.3%和71.4%(P=0.09)。SIB-IMRT组和WBRT+3D-CRT组患者的中位生存时间分别为12.5个月和8.2个月,SIB-IMRT组1、2年生存率分别为53.8%、29.6%;WBRT+3D-CRT组为36.5%、10.9%,SIB-IMRT组的总生存时间明显优于WBRT+3D-CRT组(P=0.03)。两组患者均未出现Ⅲ级以上急性神经系统不良反应以及Ⅲ级以上骨髓抑制,SIB-IMRT组放射诱发的脑水肿发生率为17.4%(4/23),WBRT+3D-CRT组为23.8%(5/21)(P=0.60);两组Ⅰ~Ⅱ级急性骨髓抑制发生率分别为30.4%(7/23)、23.8%(5/21)(P=0.62)。两组患者完成脑转移瘤住院治疗时间有显著性差异(P<0.01)。[结论]同期加量调强放疗肺癌脑转移瘤较适形序贯加量放疗疗效好,未增加急性不良反应,缩短了总治疗时间,节省了医疗资源。

[Objective] To compare the efficacy and side effects of concurrent intensity modulated radiation therapy and sequential intensity modulated radiation therapy for brain metastases from lung cancer. [Methods] Forty-four patients with brain metastasis from lung cancer admitted to our hospital from January 2018 to July 2019 were randomly divided into two groups. Twenty three patients received simultaneous integrated boost intensity-modulated radiation therapy(SIBIMRT group), with the whole brain 5-7 field IMRT of 40 Gy/20 f and tumor bed of 50 Gy/20 f. Twenty one patients received conformal sequential-intensity radiation therapy(whole brain radiotherapy + three-dimensional conformal radiation therapy, WBRT+3 D-CRT group), with the WBRT of 40 Gy/20 f and the tumor bed P-GTV of 18.4 gy/8 f. The clinical efficacy, acute adverse reactions and length of hospital stay of the two groups were compared. [Results] The objective response rate(ORR) in SIB-IMRT group and WBRT+3 D-CRT group was 82.6% and 52.4%, respectively(P=0.03). The disease control rate(DCR) of SIB-IMRT group and WBRT+3 D-CRT group was 91.3% and 71.4%, respectively(P=0.09). The median survival time of SIB-IMRT group and WBRT+3 D-CRT group was 12.5 months and 8.2 months, respectively. The1-year and 2-year survival rates of SIB-IMRT group were 53.8% and 29.6% respectively, and those of WBRT+3 D-CRT group were 36.5% and 10.9%,respectively. The total survival rate of SIB-IMRT group was significantly higher than that of WBRT+ 3 D-CRT group(P=0.03). There were no acute neurological adverse reactions >grade Ⅲ and bone marrow suppression > grade Ⅲ in both groups, the incidence of radiation-induced cerebral edema in the SIB-IMRT group was17.4%(4/23), and it was 23.8%(5/21) in the WBRT+3 D-CRT group(P=0.60). The incidence of Ⅰ~Ⅱ acute myelosuppression in the two groups was 30.4%(7/23) and 23.8%(5/21)(P=0.62). There was a significant difference between the two groups in the length of hospital stay for brain metastases(P<0.01). [Conclusion] The simultaneous intensity-modulated radiotherapy for lung cancer brain metastases is more effective than conformal sequential increase-dose radiotherapy,without increasing acute adverse reactions, it also can shorten the total treatment time, and save medical resources.