全脑放射治疗联合病灶同步推量治疗多发性脑转移瘤的剂量学及预后研究

Study on the dosimetry and prognosis of whole brain radiotherapy combined with synchronization pushing volume of lesion in patients with multiple brain metastatic tumor

目的:研究全脑放射治疗联合病灶同步推量对多发性脑转移瘤患者中剂量学及预后的影响。方法:选取在医院诊治的120例多发性脑转移瘤患者,按照不同治疗方法将采用全脑放射治疗+病灶同步推量治疗的62例患者纳入观察组,将全脑放射治疗+序贯推量治疗的58例患者纳入对照组。比较两组计量学参数、不良反应,采用Logistic回归分析观察组患者1年总生存期(OS)、1年无进展生存期(PFS)的影响因素。结果:观察组计划肿瘤靶区(PGTV)、计划靶区(PTV)的靶区适形指数(CI)明显高于对照组,PGTV的靶区均匀指数(HI)明显低于对照组,差异有统计学意义(t=14.915,t=9.928,t=6.012;P<0.05)。观察组患者1年OS有23例,1年PFS有21例,单因素分析中原发疾病、肺癌靶向治疗、分级预后评估(GPA)评分和外周血中性粒细胞淋巴细胞比值(NLR)是1年OS的影响因素(χ^(2)=4.433,χ^(2)=8.257,χ^(2)=5.939,χ^(2)=4.147;P<0.05);靶向治疗、原发疾病分级是1年PFS的影响因素(χ^(2)=5.438,χ^(2)=5.856;P<0.05);Logistic回归分析,肺癌靶向治疗是1年OS的保护因素(OR=0.272,P<0.05),低GPA评分、高外周血NLR是危险因素(OR=3.750,OR=3.000;P<0.05);肺癌靶向治疗是1年PFS的保护因素(OR=0.213,P<0.05)。两组不良反应比较,均无统计学差异。结论:全脑放射治疗联合病灶同步推量的放射治疗计划均匀度和适形度均较好,且安全性较好。低GPA评分、高外周血NLR患者预后不佳应早期给予干预措施。

Objective:To explore the effect of whole brain radiotherapy combined with synchronization pushing volume of lesion in patients with multiple brain metastatic tumor on the dosimetry and prognosis.Methods:A total of 120 patients with multiple brain metastatic tumor who were diagnosed and treated in hospital were selected.According to different treatment methods,62 patients who underwent the therapy of whole brain radiotherapy+synchronization pushing volume were divided into observation group,and 58 patients who underwent the therapy of whole brain radiotherapy+sequential pushing volume were divided into control group.The metrological parameters and adverse reaction of two groups were compared,and Logistic regression analysis was adopted to analyze the 1-year overall survival(OS)and 1-year progression-free survival(PFS)of patients in observation group.Results:The conformity indexes(CI)of plan gross target volume(PGTV)and gross tumor volume(PTV)of observation group were significantly higher than those of control group(t=14.915,t=9.928,t=6.012,P<0.05).In the observation group,23 cases were 1-year OS and 21 cases were 1-year PFS.The results of univariate analysis indicated the primary disease,targeted therapy of lung cancer,graded prognostic assessment(GPA)score and neutrophil lymphocyte ratio(NLR)of peripheral blood were influencing factors of 1-year OS(χ^(2)=4.433,χ^(2)=8.257,χ^(2)=5.939,χ^(2)=4.147,P<0.05).Targeted therapy and primary disease classification were influencing factors of 1-year PFS(χ^(2)=5.438,χ^(2)=5.856,P<0.05).The results of Logistic regression analysis indicated targeted therapy of lung tumor was a protective factor for 1-year OS(OR=0.272,P<0.05).Low GPA score and high NLR of peripheral blood were risk factors(OR=3.750,OR=3.000,P<0.05).Targeted therapy of lung tumor was a protective factor for 1-year PFS(OR=0.213,P<0.05).The difference of each adverse reaction between the two groups was not statistically significant.Conclusion:The uniformity and conformity of the radiotherapy plan that whole brain radiotherapy combined with synchronization pushing volume of lesions are favorable,and its safety is good.The prognosis of patients with low GPA score and high NLR of peripheral blood is poor and they should receive early intervention.