Is There Any Indication for Prophylactic Brain Irradiation in the Management of Small Cell Prostate Cancer?

Small cell prostate carcinoma (SCPC) is an extremely rare pathology with an aggressive behavior, characterized by early brain metastases. We describe three cases of SCPC where brain metastases occurred despite response to chemotherapy. The benefit of prophylactic brain irradiation (PBI), as part of the management of SCPC, is discussed and compared to its indications in small cell lung cancer.

Long-term results of prophylactic cranial irradiation for limited-stage small-cell lung cancer in complete remission

Background Brain metastasis is one of the most important causes of treatment failure in patients with small cell lung cancer （SCLC）. This study was conducted to evaluate the effects of prophylactic cranial irradiation （PCI） on survival and brain metastases for patients with limited stage small cell lung cancer in complete remission. Methods Fifty one patients with limited stage SCLC in complete remission after chemoradiotherapy were randomly divided into PCI group （n = 26） and control group （n = 25 ）. Patients in the PCI group received PCI at a dose of 25.2 to 30. 6 Gy in 1.8 to 2.0 Gy per fraction. The Kaplan-Meier method and Log rank test were used to analyse and compare survival rates, and X^2 test was used to compare the incidences of cranial metastases in two groups. Results There was no significant difference in clinical characteristics of patients such as age, sex, effect of treatment before PCI between the two groups. The incidence of brain metastases was 3.8% in the PCI group in contrast to 32. 0% in the control group （X^2 =5.15, P =0. 02）. The 1, 3, 5-year survival rates were 84. 6%, 42. 3%, 34. 6% respectively in the PCI group and 72.0%, 32. 0%, 24. 0% respectively in the control group, with no difference between the two groups （X^2 = 2. 25, P = 0. 13 ）. No serious sequelae were observed in patients receiving PCI. Conclusion For patients with limited stage SCLC responding completely to chemotherapy plus radiotherapy, PCI can decrease the incidence of brain metastases and improve survival rate.

Unresectable stage Ⅲ non-small-cell lung cancer: Have we made any progress?

Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage ⅢA or stage ⅢB disease. The standard of care for locally advanceddisease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage Ⅲ non-small-cell lung cancer(NSCLC) remains poor. Improving outcomes for patients with unresectable stage Ⅲ NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.

Quality assurance and safety of hippocampal avoidance prophylactic cranial irradiation in the multicenter randomized phase III trial(NCT01780675)

Objective:NCT01780675,a multicenter randomized phase III trial of prophylactic cranial irradiation(PCI)versus PCI with hippocampal sparing in small cell lung cancer(SCLC)investigated neurocognitive decline and safety.As part of quality assurance,we evaluated if hippocampal avoidance(HA)-PCI was performed according to the NCT01780675 trial protocol instructions,and performed a safety analysis to study the incidence and location of brain metastases for patients treated with HA-PCI.Methods:This retrospective analysis evaluated the quality of the irradiation given in the randomized controlled trial(RCT)comparing SCLC patients receiving PCI with or without hippocampal avoidance,using intensity mod-ulated radiotherapy(IMRT)or volumetric modulated arc therapy(VMAT).The dose distribution for each patient receiving HA-PCI was retrieved and analyzed to evaluate if the treatment dose constraints were met.A ques-tionnaire was sent out to all participating sites,and data on radiotherapy technique,pre-treatment dummy runs,phantom measurements and treatment electronic portal imaging device(EPID)dosimetry were collected and analyzed.As part of the safety analysis,the follow-up magnetic resonance imaging(MRI)or computerized to-mography(CT)scans on which cranial disease progression was first diagnosed were collected and matched to the radiotherapy planning dose distribution.The matched scans were reviewed to analyze the location of the brain metastases in relation to the prescribed dose.Results:A total of 168 patients were randomized in the NCT01780675 trial in 10 centers in the Netherlands and Belgium from April 2013 until March 2018.Eighty two patients receiving HA-PCI without evidence of brain metastases were analyzed.All patients were treated with 25 Gy in 10 fractions.Dummy runs and phantom measurements were performed in all institutions prior to enrolling patients into the study.The radiotherapy(RT)plans showed a median mean bilateral hippocampal dose of 8.0 Gy,range 5.4-11.4(constraint≤8.5 Gy).In six patients(7.3%)there was a protocol violation of the mean dose in one or both hippocampi.In four of these six patients(4.9%)the mean dose to both hippocampi exceeded the constraint,in 1 patient(1.2%)only the left and in 1 patient(1.2%)only the right hippocampal mean dose was violated(average median dose left and right 8.9 Gy).All patients met the trial dose constraint of V 115%PTV≤1%;however the D max PTV constraint of≤28.75 Gy was violated in 22.0%of the patients.The safety analysis showed that 14 patients(17.1%)developed cranial progression.No solitary brain metastases in the underdosed region were found.Two out of 11 patients with multiple brain metastasis developed metastasis in the underdosed region(s).Conclusions:The radiotherapy quality within the HA-PCI trial is performed according to the protocol guidelines.The dose constraints to the hippocampi are met in the vast majority of cases.In all patients,the volume of the brain for which a higher dose was accepted,is according to the trial.However,within this volume there are small areas with higher doses than advised.

GOECP/SEOR radiotherapy guidelines for small-cell lung cancer

Small cell lung cancer(SCLC)accounts for approximately 20%of all lung cancers.The main treatment is chemotherapy(Ch).However,the addition of radiotherapy significantly improves overall survival(OS)in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch.Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non-metastatic patients.The 5-year OS rate in patients with limited-stage disease(non-metastatic)is slightly higher than 30%,but less than 5%in patients with extensive-stage disease(metastatic).The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis,planning,and treatment of SCLC.These guidelines emphasise treatment fields,radiation techniques,fractionation,concomitant treatment,and the optimal timing of Ch and radiotherapy.Finally,we discuss the main indications for reirradiation in local recurrence.

New perspectives in the management of small cell lung cancer

The treatment of small cell lung cancer(SCLC)is a challenge for all specialists involved.New treatments have been added to the therapeutic armamentarium in recent months,but efforts must continue to improve both survival and quality of life.Advances in surgery and radiotherapy have resulted in prolonged survival times and fewer complications,while more careful patient selection has led to increased staging accuracy.Developments in the field of systemic therapy have resulted in changes to clinical guidelines and the management of patients with advanced disease,mainly with the introduction of immunotherapy.In this article,we describe recent improvements in the management of patients with SCLC,review current treatments,and discuss future lines of research.

海马保护对局限期小细胞肺癌预防性脑照射患者认知功能障碍的疗效

目的观察海马保护对局限期小细胞肺癌行预防性脑照射(PCI)患者认知功能障碍等相关指标的影响。方法收集临沂市肿瘤医院2017年1月—2021年2月局限期小细胞肺癌患者82例,根据行PCI是否进行海马保护分为观察组和对照组,每组41例。观察组在行PCI时实行海马保护,对照组在此过程中不实行海马保护。评价两组患者放疗前后的神经认知功能、生活自理能力、不良反应及生存情况。结果两组患者放疗前蒙特利尔认知评估量表(Mo-CA)评分比较,P>0.05。放疗后第3、6和12个月,两组患者Mo-CA评分均低于放疗前(P<0.05)且观察组Mo-CA评分均高于对照组(P<0.05)。两组患者放疗后日常生活活动能力量表(ADL)评分均下降,且3个月及6个月时均为轻度功能障碍,但两组患者ADL评分比较,P>0.05。放疗后12个月观察组ADL评分显著高于对照组(P<0.05)。两组患者放疗不良反应、两年脑转移及生存率比较,P>0.05。结论将海马保护技术应用于PCI技术治疗局限期小细胞肺癌,可改善对患者的神经认知功能及生活自理能力,提高患者的生活质量。

局限期小细胞肺癌预防性脑照射后脑转移相关危险因素分析

目的:明确局限期小细胞肺癌患者行预防性脑照射(prophylactic cranial irradiation, PCI)后发生脑转移的危险因素,并对相关因素进行分析。以筛选出不能从PCI中获益的人群,为PCI的临床应用提供参考。方法:回顾性分析2011年08月至2019年12月在我院接受过PCI的167例局限期小细胞肺癌患者的病历资料。采用SPSS 26.0统计软件对病历资料进行统计分析。用Kaplan-Meier法计算脑转移发生率及总生存率,并用Log-rank法进行检验。采用Cox回归对影响脑转移及总生存的危险因素进行单因素及多因素分析。结果:局限期小细胞肺癌患者PCI后1、2、3年脑转移率分别为3.8%、12.7%、18.9%。单因素及多因素分析结果显示原发肿瘤为T_(4)期(P=0.004,HR=7.06,95%CI:1.86~26.82)是影响患者PCI后脑转移的危险因素,T_(2)期(P=0.008,HR=2.48,95%CI:1.26~4.89)、T_(3)期(P=0.003,HR=3.38,95%CI:1.49~7.47)、T_(4)期(P=0.001,HR=3.87,95%CI:1.79~8.35)是影响患者总生存的危险因素。结论:较高的T分期是局限期小细胞肺癌患者PCI后脑转移及总生存的独立危险因素。即使T_(4)期患者PCI后脑转移发生率高于其他期别,但仍能够从PCI中获益。

局部晚期非小细胞肺癌术后脑转移高危因素分析

背景与目的脑转移已经成为局部晚期非小细胞肺癌(NSCLC)治疗失败的最主要因素之一。预防性脑放射是否用于NSCLC目前仍没有定论。本研究的目的是评估局部晚期NSCLC术后发生脑转移的高危因素,以便确定预防性脑放射的指征。方法回顾性分析223例在我院行外科手术的Ⅲ期NSCLC患者,分析其脑转移的高危因素,建立数学模型。结果全组病例中位生存期28个月,1、2、3年生存率分别为84.3%、56.9%、44.8%。全组病例脑转移发生率为38.1%(85/223)。多个区域纵隔淋巴结转移、多个纵隔淋巴结转移以及非鳞癌患者的脑转移发生率显著高于单区域纵隔淋巴结转移、纵隔淋巴结转移数目较少以及鳞癌患者(P=0.000,P=0.000,P=0.013)。脑转移的高危数学模型:logit(P)=8.215-0.903×纵隔淋巴结阳性数-0.872×手术性质-0.714×病理类型-1.893×纵隔淋巴结转移程度-0.948×病理分期-1.034×术后化疗。P≥0.44为脑转移高危人群。结论局部晚期NSCLC术后脑转移高危因素有:非鳞癌、纵隔多区域淋巴结转移、纵隔多个淋巴结转移。P≥0.44可能作为局部晚期NSCLC患者在临床研究中行预防性脑放射的参考指征。

ⅢA期非小细胞肺癌患者术后脑转移高危临床因素分析

目的:本文探讨完整切除ⅢA期非小细胞肺癌(Non-small-cell lung cancer,NSCLC)术后高危脑转移的临床特征,分析ⅢA期NSCLC患者行预防性脑放射的指征。方法:对193例完整切除术后的ⅢA期NSCLC患者进行回顾性分析,观察术后是否出现脑转移对生存的影响,并分析患者的临床资料,找出ⅢA期NSCLC术后脑转移的高危临床因素。结果:全组患者的中位生存期为829(16～3092)天,累计1、2、3、4、5年生存率分别为80.3%、54.8%、37.6%、29.7%和21.9%。整个病程出现脑转移的患者有67例(34.7%),第1、2、3年脑转移发生率分别为15.0%、31.5%、40.1%。终生有脑转移患者的总生存和无复发生存均明显差于终生无脑转移的患者(P=0.011和P=0.0004),两者的中位生存期分别为700天和928天,终身是否出现脑转移是影响预后的重要独立因素(P=0.04,HR=1.546,95%CI:1.020～2.343)。Cox预后多因素回归分析发现影响脑转移的因素为术前血清学CEA水平(P=0.014,HR=2.152,95%CI:1.169～3.963),是否鳞癌(P=0.021,HR=0.400,95%CI:0.184～0.873)。结论:终身是否出现脑转移是影响预后的重要独立因素,ⅢA期术后脑转移高危因素为术前血清学CEA升高和病理类型为非鳞癌。

全身化疗联合局部放疗对广泛期小细胞肺癌患者生存期的影响

目的:评价全身化疗联合局部放疗对广泛期小细胞肺癌(extensive stage small cell lung cancer,ES-SCLC)患者生存期的影响。方法:回顾性分析46例ES-SCLC患者临床资料,根据是否接受转移灶局部治疗、原发灶放疗及全脑预防性照射治疗(prophylactic cranial irradiation,PCI),比较其临床特征及生存结果。结果:单部位、多部位及未行转移灶局部治疗患者的中位生存期(median survival time,MST)分别为12.1个月、18.5个月和9.5个月;限期性、择期性局部治疗及未行转移灶局部治疗患者的MST分别为10.7个月、15.8个月和9.1个月,总生存期(overall survival,OS),比较差异有统计学意义(P<0.01)。放化疗与单纯化疗者MST分别为13.7个月和8.7个月;行PCI者与未行PCI者MST分别为18.4个月和10.1个月,OS比较差异有统计学意义(P<0.01)。Cox多因素回归分析显示,转移灶局部治疗、原发灶放疗及PCI是ES-SCLC患者的保护性独立预后因素(P<0.01)。结论:在全身化疗基础上行转移灶局部治疗、原发灶放疗及PCI均能延长ES-SCLC患者生存期。

奥西替尼联合颅脑放疗治疗非小细胞肺癌脑转移效果观察

目的奥西替尼联合颅脑放疗治疗非小细胞肺癌脑转移的价值和意义。方法选取非小细胞肺癌脑转移患者80例作为研究对象,应用计算机分组软件平均分组,单纯接受颅脑放射治疗患者40例设为对照组,奥西替尼联合颅脑放疗治疗患者40例设为试验组,比较2组患者临床疗效、颅内及颅外无进展生存期、血清癌胚抗原(carcinoembryonic antigen,CEA)和血管内皮生长因子(vascular endothelium growth factor,VEGF)表达水平。结果试验组临床疗效优于对照组,客观缓解率和疾病控制率高于对照组,颅内、颅外无进展生存期长于对照组(P<0.05或P<0.01);治疗后,2组血清CEA、VEGF表达水平明显低于治疗前,试验组血清CEA、VEGF表达水平明显低于对照组(P<0.01)。结论奥西替尼联合颅脑放疗治疗非小细胞肺癌脑转移,可以提高临床效率,降低CEA、VEGF表达水平,延长患者生存期,效果显著,值得临床使用。

小细胞肺癌术后化疗或放化疗后预防性脑照射的临床观察

目的:探讨小细胞肺癌术后化疗或放化疗后预防性脑照射(PCI)能否降低脑转移率,提高生存率。方法:1990年6月～1995年7月我院治疗小细胞肺癌术后化疗或放化疗后预防性脑照射30例(PCI组),男22例,女8例。临床分期分别为Ⅰ、Ⅱ和Ⅲa期各9、15和6例,化疗方案为CAE方案(C:环磷酰胺,A:阿霉素,E:依托铂甙)或EP方案(E:依托铂甙,P:顺铂),预防性脑照射剂量为30Gy/15次,1.8～2.0Gy/次;同期术后化疗或放化疗40例(对照组),男28例,女12例,Ⅰ、Ⅱ和Ⅲa期各10、20和10例。结果:脑转移率PCI组10.0%,对照组52.5%,两组间有显著的统计学意义(χ2=13.73,P<0.001)。PCI组1、3、5年生存率分别为83.3%、60.0%和20.0%,对照组1、3、5年生存率分别为80.0%、47.5%和15.0%,PCI组和对照组Ⅰ、Ⅱ和Ⅲa期5年生存率分别为60.0%和55.6%;、42.9%和38.5%;25.0%和10.0%,两组均无统计学差异。结论:小细胞肺癌术后化疗或放化疗后预防性脑照射可以降低脑转移率,是否能提高生存率,因例数较少难下确切的结论。

2023年第1版NCCN小细胞肺癌临床实践指南解读

2023年第1版NCCN小细胞肺癌(small cell lung cancer,SCLC)临床实践指南主要对接受手术治疗的局限期SCLC进行预防性脑照射的人群进行了更加明确的规定,增添了局限期SCLC胸部放疗最新的研究进展,对>4个月生存的部分脑转移SCLC海马保护的全脑放疗给予了推荐,重新界定了铂类治疗再挑战的人群。本文将对以上更新内容进行介绍和解读。

预防性颅脑照射在完全缓解的小细胞肺癌中应用的系统评价

目的:系统评价预防性颅脑照射(PCI)在完全缓解(CR)的小细胞肺癌(SCLC)中应用的临床价值及最佳治疗剂量。方法:计算机检索PubMed、EMBASE、Cochrane Library和中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库、万方数据库,同时从参考文献中追溯查找。收集国内外有关的随机对照实验(RCT),评价纳入文献的方法学质量,并利用RevMan5.0软件进行Meta分析。结果:共纳入15个研究(2233例),其中13个RCT为行PCI与不行PCI(no-PCI)的对照,2个RCT为标准剂量(25Gy)与较高剂量(36Gy)的对照。Meta分析结果显示:相对于no-PCI组,PCI可提高SCLC患者的1、3、5年生存率[OR=1.51,95%CI(1.14-2.01)、OR=1.77,95%CI(1.33-2.35)、OR=1.57,95%CI(1.09-2.25)]和无瘤生存率[OR=2.43,95%CI(1.76-3.34)],降低脑转移率[OR=0.29,95%CI(0.19-0.46)]和其他转移率[OR=0.59,95%CI(0.43-0.80)],而在局部区域复发率[OR=0.89,95%CI(0.66-1.21)]方面无差异;与较高剂量组相比,标准剂量组可提高SCLC患者的1年生存率[OR=1.43,95%CI(1.07-1.92)]和1年无瘤生存率[OR=1.43,95%CI(1.05-1.95)],在改善SCLC患者的2年生存率[OR=1.23,95%CI(0.91-1.66)]、3年生存率[OR=1.29,95%CI(0.94-1.76)]、2年无瘤生存率[OR=1.22,95%CI(0.89-1.67)]、3年无瘤生存率[OR=1.22,95%CI(0.88-1.70)]方面无差异,但在1年脑转移发生率[OR=1.74,95%CI(1.16-2.60)]方面要高于较高剂量组。结论:在经化疗和放射治疗后完全缓解的SCLC患者中,PCI能提高总生存率和无瘤生存率,并能降低脑转移及其他远处转移率,可作为一种有效的预防治疗手段。较高剂量PCI组并不能显著降低脑转移总发生率和死亡率,故认为25Gy的PCI是标准治疗剂量。

螺旋断层和旋转调强技术在小细胞肺癌脑预防放射治疗海马保护的剂量学研究

目的:探讨螺旋断层(TOMO)和旋转调强(Rapid Arc)技术在小细胞肺癌脑预防放射治疗海马保护的剂量学特点,为临床选择理想的放射治疗技术提供依据。方法:选取8例局限期小细胞肺癌患者,计划靶区(PTV)为全脑避开海马减量区(海马外扩5 mm),处方剂量为25 Gy/10 F,分别设计TOMO和Rapid Arc两种计划,通过剂量体积直方图(DVH)统计分析靶区和各危及器官的剂量参数,并评估治疗计划的机器跳数和治疗时间。组间对比采用配对t检验。结果:TOMO计划靶区PTV的D_(mean)及靶区剂量均匀指数(HI)优于Rapid Arc计划,且差异有统计学意义(t=3.512,t=3.594;P<0.05);TOMO计划左右海马的D_(max)和D_(mean)明显低于Rapid Arc计划,差异有统计学意义(t=13.254,t=4.545,t=19.656,t=4.533;P<0.05);TOMO计划的左右晶体D_(max)、左右视神经D_(max)、视交叉D_(max)、脑干D_(max)及左内耳D_(max)均低于Rapid Arc,差异有统计学意义(t=16.912,t=26.043,t=4.495,t=3.451,t=4.495,t=3.378,t=3.444;P<0.05);左右眼球D_(max)和右内耳D_(max)差异无统计学意义(t=0.256,t=0.496,t=1.289;P>0.05);在治疗效率上,TOMO治疗时间长于Rapid Arc。结论:TOMO和Rapid Arc计划在海马保护脑预防放射治疗均可达到临床要求,TOMO计划在靶区剂量分布、海马和正常组织保护具有一定的优势;而Rapid Arc计划治疗时间短,效率高。

预防性全脑放疗在手术完全切除小细胞肺癌的应用

1文献来源Xu J，Yang H，Fu X，et al. Prophylactic cranial irradiation for patients with surgically resected small cell lung cancer［J］. J Thorac Oncol，2017，12（2）：347-353.2证据水平4。3背景预防性全脑放疗（prophylactic cranial irradiation，PCI）是一线治疗反应良好的局限期或者广泛期小细胞肺癌患者的标准治疗方法，目前完全切除术后的小细胞肺癌患者行PCI的建议主要是基于未接受手术患者行PCI的临床试验数据。4目的通过病历回顾，探索PCI在完全切除术后小细胞肺癌患者中的作用。

无锁骨上淋巴结转移的局限期小细胞肺癌颈部预防照射临床分析

目的:比较颈部预防照射对无锁骨上淋巴结转移的局限期小细胞肺癌预后的影响。方法:回顾性分析1998年2月至2005年12月间天津医科大学附属肿瘤医院有完整记录的88例局限期小细胞肺癌临床资料,分为颈部预防照射组与无颈部预防照射组。比较两组患者生存率、复发率、远转率、颈部远转率。结果:颈部预防照射组与无颈部预防照射组1年生存率分别为:82.00%、84.20%(P=0.785),3年生存率42.86%、52.63%(P=0.675),5年生存率26.67%、31.42%(P=0.641);1年复发率9.09%、12.50%(P=0.663),3年复发率39.39%、32.00%(P=0.562),5年复发率61.54%、47.62%(P=0.341);1年远转率27.08%、25.71%(P=0.889),3年远转率68.18%、57.14%(P=0.312),5年远转率75.00%、70.00%(P=0.642)。预防照射组与未预防照射组分别有3例与5例患者2年内发生颈部淋巴结转移,均伴有其他部位的远处转移灶,该8例患者均死于别处转移。2年颈部淋巴结转移率分别为8.33%与18.52%,无显著性区别(P=0.230),平均生存期分别为25.67、27.40个月。结论:颈部预防照射未能显著提高患者生存率、降低复发率、远转率,特别是颈部远处转率。颈部预防照射在无锁骨上淋巴结转移的局限期小细胞肺癌治疗中不是必需的放疗靶区。

局限期小细胞肺癌脑预防照射研究进展

随着放化疗等综合治疗手段的应用,局限期小细胞肺癌的局控率和生存率均有了提高,然而脑转移成为影响有长期生存可能患者生存质量的重要因素。本文综述脑预防照射在局限期小细胞肺癌患者中应用的可行性、结果及可能引起的放疗后期毒性,及脑预防照射的开始时间、分割方式、放疗剂量等方面。

87例非小细胞肺癌脑转移三维适形放疗疗效分析

目的:探讨非小细胞肺癌脑转移三维适形放疗联合全脑照射的疗效及预后因素。方法:回顾性分析1997年12月至2003年12月在本院行三维适形放疗的87例非小细胞肺癌脑转移患者的临床资料,所有病例先行全脑照射,然后缩野至局部病灶行三维适形低分割推量照射。用Kaplan-meier法分析局部控制率及生存率,预后多因素分析用COX比例风险模型。结果:中位生存时间为14个月,12个月、24个月生存率分别为53%、20%;6个月、12个月局部控制率分别为99%、93%。多因素分析提示颅脑外活动性病灶(P=0.006)、脑转移灶数量(P=0.035)、转移间隔时间(P=0.040)是独立的生存预后因素。结论:三维适形放疗联合全脑照射可有效控制非小细胞肺癌脑转移灶,不良反应可耐受。