伽玛刀治疗脑转移瘤预后影响因素分析

Prognostic factors of gamma knife therapy for brain metastases

目的回顾性分析伽玛刀治疗脑转移瘤患者预后的主要影响因素。方法收集2017—2021年间在我院神经外科伽玛刀治疗中心收治的脑转移瘤患者124例,有效成功随访101例。随访时间1~47个月,其中男63例,女38例;年龄31~87岁,平均年龄59岁;病灶数量1~7个,平均1.7个,总共176个;病灶直径0.5~3.5 cm,平均1.9 cm;卡氏评分40~100分,平均70分;行1次伽玛刀治疗81例,行2次伽玛刀治疗15例,行3次伽玛刀治疗5例;周边剂量16~20 Gy,中心剂量32~40 Gy。从性别、年龄、卡氏评分、转移瘤数量、肿瘤直径、治疗周边剂量、生存率和生存时间进行预后因素分析。结果生存时间1~47个月,平均生存期15.7个月,中位生存期12个月;病灶缩小82例,完全消失12例,维持不变5例,肿瘤局部控制率98%;病灶增大2例,占2%,改为开颅手术治疗;新发病灶18例,均进行了第2次和第3次伽玛刀治疗;原有肢体偏瘫症状均出现明显改善或消失;无明显放射性脑损伤发生。结论脑转移瘤患者适宜伽玛刀治疗,术前卡氏评分和治疗的周边剂量是影响患者预后的主要因素,其中卡氏评分影响患者的生存时间,合适的周边剂量影响患者的生存质量。

Objective Major prognostic factors of patients with brain metastases(BMS)were retrospectively analyzed.Methods A total of 124 patients with BMS admitted to gamma Knife Treatment Center of Neurosurgery from July 2017 to April 2021 were collected and 101 patients were effectively and successfully visited.101 cases were followed up for 1-47 months.Among them,63 were male and 38 were female.The maximum age was 87 years old,the minimum age was 31 years old,and the average age was 59 years old.The number of lesions was at least 1 and at most 7,with a total of 176 lesions and an average of 1.7 lesions.The maximum diameter of lesions was 3.5 cm,the minimum was 0.5 cm,and the average diameter was 1.9 cm.The highest SCORE of KPS was 100,the lowest score was 40,and the average score was 70,81 Patients were treated with gamma knife once and 15 cases twice.Gamma knife was performed three times in 5 cases.Peripheral dose was 16-20 Gy and central dose was 32-40 Gy.Prognostic factors were analyzed from sex,age,card score,number of metastases,tumor diameter,treatment peripheral dose,survival,and survival time.Results The survival time was 1-47 months,the average survival time was 15.7 months,and the median survival time was 12 months.82 cases of lesions were gradually reduced.12 cases disappeared completely during the return visit.5 cases remained unchanged.Local tumor control rate was 98%;2 cases with lesions increased(2%)were treated with craniotomy.18 cases of new lesions were treated with gamma knife multiple times.The hemiplegia symptom of hemiplegia patient appears obvious improvement or disappear.No radiation brain injury occurred.Conclusions Gamma knife therapy is suitable for patients with brain metastases.KPS score at the beginning of gamma knife treatment is the main factor affecting the patient's survival time and the use of reasonable peripheral dose will affect the quality of life of patients.