133例非小细胞肺癌脑转移的综合治疗分析

Combined treatment of brain metastasis in non-small cell lung cancer

目的 通过回顾性分析探讨影响非小细胞肺癌脑转移治疗效果的预后因素。方法 对1 33例非小细胞肺癌脑转移患者进行以全脑放射治疗为主结合其他方法的治疗。脑转移症状缓解定义为脑部放射治疗结束后 1个月 ,50 %以上的症状和体征消失。将脑转移时原发灶控制与否、脑外转移灶、单发或多发脑转移、化疗周期等因素进行多因素分析。结果 所有患者经放射治疗后脑转移灶症状缓解率达 88% ,缓解期为 1 .5～ 55 .0个月 ,中位缓解期为 6个月 ;全脑放射治疗后CT或MRI显示脑转移灶局部控制率为 83 % ;全组中位生存期为 6个月 ,1、2年生存率分别为 2 4 .5 %和 7.8%。经多因素分析显示生存率与多发脑转移、原发灶未控呈负相关 ,而与化疗 3周期以上呈正相关。结论 影响非小细胞肺癌脑转移的主要因素是脑转移时原发灶控制与否、多发或单发脑转移、化疗周期数。对于单发脑转移、脑转移时原发灶控制以及身体条件能够耐受 3周期以上化疗的患者 。

Objective To identify patients with brain metastasis from non-small c ell lung carcinoma who would benefit from more intensive treatment strategies. Methods Between January 1995 and January 2001, 133 patients with brain metastasi s from non-small cell lung cancer were irradiated with palliative intent. Palliation was defined as 50% or more regression of neurological signs and sympt oms o n e month after the completion of cranial radiotherapy. The following factors, suc h as local control of the primary tumor at the time of developing brain metastas is, presenc e of metastasis other than brain, multiplicity of brain metastasis on CT scan , time of brain metastasis and chemotherapy cycle were evaluated wi th multivariate analysis. Results Palliation was accomplished in 88% of patients lasting from 1.5 to 55.0 months (median 6 months). The overall median survival was 6 months. The 1- and 2-year survival rates were 24.5% and 7. 8%. By multivariate analysis, survival was significantly decreased in the presen ce of uncontroled primary tumor, more than one brain metastatic lesion and less than three cycles of chemotherapy. Conclusions For patients with brain metastasi s from non-small cell lung carcinoma, the presence of uncontroled primary tumor at the time of developing brain metastasis, more than one brain metastatic lesio n and less than three cycles of chemotherapy are factors that can be used to dis tinguish patients with an unfavorable outcome. In patients with favorable progno stic factors and thus longer survival probability, the role of boost dose after whole brain radiotherapy , surgical resection or other modalities need to be investigated.