大于3cm脑转移瘤分次立体定向放疗初探  

Fractionated stereotactic radiotherapy for brain metastases larger than 3 centimeters

作　　者：姜雪松[1] 肖建平[1] 宋一昕[1] 张可[1] 翟万聪[1] 张烨[1] 李晔雄[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2009年第3期176-180,共5页Chinese Journal of Radiation Oncology

基　　金：北京市自然科学基金（3042015）;科技部重大基础研究前期研究专项资助（2005CCA0300）

摘　　要：目的回顾分析〉3cm脑转移瘤分次立体定向放疗（FSRT）的初步疗效，评价其临床应用价值。方法搜集2006年前10年间采用FSRT且资料完整的直径〉3cm的脑转移瘤患者47例，其中男34例，女13例，年龄31～87岁（中位值58岁）。原发灶病理为腺癌19例，鳞癌7例，小细胞癌7例，腺鳞癌3例，黑色素瘤2例，低分化癌、透明细胞癌、移行细胞癌各1例，病理类型不明6例。初治组26例，复发组21例。脑转移瘤直径3．1—6．0cm（中位值3．8cm）。计划靶体积2．5—33．8cm^3（中位值9．4cm^3）。FSRT总剂量16～68Gy（中位值31Gy）分2～15次（中位值5次）。原发灶治疗方法：手术23例，放、化疗22例，未治2例。结果随访截止2008年4月，随访率为100％，满5年随访的例数为28例。1、2、5年局部控制率分别为49％、44％、44％。中位生存期11．0个月（0．5—88．0个月，95％CI＝8．1～13．8个月）；1、2、5年总生存率分别为40％、17％、6％。在死亡的46例中，21例死于颅内病变进展，17例死于颅外病变进展，8例死于其他原因。结论FSRT通过分次治疗、个体化给量、全脑放疗或一程FSRT后推量，能有效控制最大径〉3cm的脑转移瘤、延长生存并改善生活质量。Objective To assess the feasibility and outcomes of fractionated stereotactic radiation therapy（FSRT） for brain metastases more than 3 cm in diameter. Methods From September 1996 to July 2006,47 patients（34 male and 13 female）with brain metastases larger than 3 cm were treated with FSRT. The median age was 58 （range, 31-87 ） years old. Pathologic diagnosis was adenocarcinoma in 19 patients, squamacarcinoma in 7, small cell carcinoma in 7, adeno-squamacarcinoma in 3, melanoma in 2, poor differentiated carcinoma,clear cell carcinoma, transitional cell carcinoma each in 1, and unknown in 6. FSRT was delivered as initial treatment for 26 patients, and as salvage therapy for 21. The largest diameter of brain metastases was 3.1 -6.0 cm（ median,3.8 cm）. Planning target volume were 2.5 - 33.8 cm^3 （ median,9.4 cm^3）. The median dose of FSRT was 30（ range, 16-57 ） Gy in 5 （ range ,2 - 11 ） fractions. The treatment for primary tumor was surgery in 23 patients, radiotherapy and/or chemotherapy in 22, and none in 2. Results The last follow up was in April 2008. All patients were followed up and 33 had follow up more than 5 years. The 1-,2- and 5-year local control rate was 49% ,44% and 44% ,respectively. The median survival time was 11 months （ range,0.5 - 88.0 months, 95% CI = 8.1 - 13.8 months ）. The corresponding overall survival rate was 40% ,17% and 6% ,respectively. There were 46 patients died by the last follow up,including 21 died from brain metastases, 17 died from extracranial progression, and 8 died from other causes. Conclusion FSRT is safe and beneficial for selected patients with brain metastases larger than 3 cm.

关 键 词：肿瘤转移 脑/放射疗法 放射疗法 分次立体定向 预后 

分 类 号：R686[医药卫生—骨科学]