非小细胞肺癌脑转移低分割放疗疗效分析

摘要/Abstract

摘要： 目的评价非小细胞肺癌脑转移放射治疗中全脑照射的作用,分析生存预后因素。方法对93例非小细胞肺癌脑转移患者进行放射治疗,其中68例先行全脑照射(全脑照射组),然后行局部三维适形低分割放疗;25例只行三维适形低分割放疗(低分割组)。用Kaplan-meier法统计生存率及局部控制率,以Cox比例风险模型分析影响患者生存的预后因素。结果全脑照射组中位生存时间14个月,1、2年生存率分别为50%、27%;低分割组中位生存时间12个月,1、2年生存率分别为45%、15%;两组无显著差异性(log-rank,P=0.502)。全脑照射组与低分割组1年颅脑局部控制率分别为90%、70%,两组有显著差异(P=0.028)。多因素分析提示颅外活动性病灶(P=0.002)、KPS评分(P=0.034)是影响生存的独立预后因素。结论非小细胞肺癌脑转移三维适形放疗联合全脑照射无生存得益,而有助于提高局部控制率。

Abstract: Objective To evaluate the therapeutic effect of of whole brain irradiation (WBI) in the treatment of brain metastases of non-small-cell lung carcinoma and analyze the factors affecting the patients’ survival. Methods Ninety-three cases of brain metastases of non-small-cell lung carcinoma receiving radiotherapy between January 1998 and February 2004 were retrospectively reviewed. Of these patients, 68 were treated with three-dimensional conformal hypofractionated radiotherapy (3D-CRT) following WBI, while the other 25 underwent 3D-CRT alone. Kaplan-Meier method was used to analyze the survival rate and local control rate, and Cox proportional hazards model employed for determining prognostic factors influencing the patients’ survival. Results The overall median actuarial survival of the patients was 14 months in the 3D-CRT+WBI group with 1- and 2-year actuarial survival rates of 50% and 27%, respectively, showing no significant difference from 3D-CRT group, which had a median survival of 11 months and 1- and 2-year survival rates of 45% and 15% (P=0.502, log-rank test). Actuarial 1-year local control rate in 3D-CRT+WBI group was 90% as compared to 70% in 3D-CRT group (P=0.028, log-rank test). In multivariate analyses, active extracranial disease (P=0.002) and Karnofsky Performance Scale score (P=0.034)were identified as the independent prognostic factors for the patients’ survival. Conclusion WBI prior to 3D-CRT does not benefit the patients with brain metastases of non-small cell lung carcinoma for their survival, but may help improve the local control rate.

中图分类号:

R734.2

邱幸生, 陈龙华, 陈永清. 非小细胞肺癌脑转移低分割放疗疗效分析[J]. 南方医科大学学报, 2005, 25(11): 1375-1378.

QIU Xing-sheng, CHEN Long-hua, CHEN Yong-qing. Three-dimensional conformal hypofractionated radiotherapy for brain metastases of non-small-cell lung carcinoma:implications for whole brain irradiation[J]. Journal of Southern Medical University, 2005, 25(11): 1375-1378.

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