立体定向放射外科治疗脑转移瘤预后因素分析

摘要/Abstract

摘要： 目的评价立体定向放射外科(SRS)治疗脑转移瘤的效果及预后因素。方法回顾性分析1994～2002年在巴黎Tenon医院放疗科行SRS(X线刀)治疗的脑转移患者102例,包括单发者78例,多发者24例,102例患者共有转移灶131个,转移灶最大直径≤4cm。其中18位患者同时接受全脑放疗(WBRT),93例患者120个转移灶有影像学随访。计算患者的生存期及局控率,并对潜在预后因素分别进行单因素和多因素分析。结果总体局控率和1年局控率分别为91.7%和85.3%,102例患者的中位生存期为11个月。单因素分析表明只有转移灶体积是影响局控率的预后因素;KPS>70、年龄≤60、无颅外其他器官转移以及SRS前行全脑照射是影响生存期的预后因素。多因素分析表明仅KPS评分为生存独立预后因素。结论 SRS是脑转移的有效治疗方式,多种因素影响其预后。

Abstract: Objective To assess the clinical outcome of brain metastatic tumors treated with linac-based stereotactic radiosurgery (SRS) and evaluate the potential prognostic factors. Methods We reviewed 102 patients with 131 brain metastatic tumors treated with a linac-based SRS from 1994 to 2002, including 78 patients with solitary and 24 with multiple brain metastases, with the diameter of tumor all within 4 cm. Among these 102 patients, 18 received planned whole-brain radiation therapy (WBRT) before or after SRS. Ninety-three patients with 120 lesions were evaluated for local tumor control analysis with follow-up imaging data. The patients’ survival and local control of the tumors were estimated using Kaplan-Meier method, and the potential prognostic factors were analyzed with univariate and multivariate analysis. Results The overall local tumor control rate and the actuarial local tumor control rate at 1 year were 92.5% and 87.6%, respectively. The tumor volume was the single significant predictor for local tumor control (P=0.035). The median survival of the 102 patients was 11 months. In univariate analysis, patients aged over 60 years (P=0.038) with KPS score above 70 (P=0.001), absence of extracranial metastases (P=0.031) and administration of planned WBRT (P=0.025) were significant factors for survival. After adjustment of multivariate analysis, only KPS score was identified as the independent predictor (P=0.033). Conclusion SRS is an effective method for treatment of brain metastases, and multiple factors may affect the local tumor control and survival of the patients.

中图分类号:

徐本华¹, 韩露², 林少俊², Touboul E³. 立体定向放射外科治疗脑转移瘤预后因素分析[J]. 南方医科大学学报, 2005, 25(11): 1425-1428.

XU Ben-hua¹, HAN Lu², LIN Shao-jun², Touboul E³. Prognostic factors for brain metastatic tumors treated with stereotactic radiosurgery[J]. Journal of Southern Medical University, 2005, 25(11): 1425-1428.

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