脑转移瘤X线立体定向放射治疗的疗效及影响因素  

Efficacy of X-ray stereotactic radiotherapy on brain metastases and prognostic analysis

作　　者：魏微[1,2] 邓美玲[1,2] 吴少雄[1,2] 曾智帆[1,2] 李凤岩[1,2] 王汉渝[1,2] 包勇[1,2] 高远红[1,2] 陈立新[1,2] 

机构地区：[1]华南肿瘤学国家重点实验室,广东广州510060 [2]中山大学肿瘤防治中心放射治疗科,广东广州510060

出　　处：《癌症》2010年第2期217-222,共6页Chinese Journal of Cancer

摘　　要：背景与目的:X线立体定向放射治疗(X-ray stereotactic radiotherapy,SRT)是治疗脑转移瘤的有效方法之一,该研究意在评价脑转移瘤患者SRT的疗效以及影响预后的因素。方法:自1999年7月至2004年12月止,78例脑转移瘤患者在本中心接受SRT方式治疗。其中,49例为单发病灶,29例为多发(2～6个)病灶,总病灶数为122个。38个病灶采用SRT单次治疗,中位处方剂量为15Gy(11～24Gy)。84个病灶采用SRT分次(2～6次)治疗,中位处方剂量为24Gy(11～40Gy)。39例SRT联合全脑放疗30～40Gy。无进展生存率(progression-free survival,PFS)和总生存率(overall survival,OS)分析采用Kaplan-Meier法,单因素和多因素分析分别采用log-rank法和Cox模型。结果:中位生存时间12.9(1.7～77.4)个月。1年颅内PFS为87.4%,1和2年OS分别为53.9%和25.8%。单因素分析显示治疗前KPS(karnofsky performance state)≥70、颅外肿瘤获控制和SRT联合全脑放疗的1年OS明显高于KPS<70、颅外肿瘤未控制和单纯SRT,分别为60.7%对29.4%(P=0.002),69.0%对44.9%(P=0.005),和64.1%对43.4%(P=0.03);联合全脑放疗的获益主要表现在颅外肿瘤获控制或脑病灶数≥2个者。多因素分析显示KPS评分和颅外病灶是否控制是影响总生存的独立因素。结论:采用SRT方式治疗脑转移瘤是有效和安全的,对颅外肿瘤获控制或颅内多发病灶者,SRT联合全脑放疗有利于延长患者的生存期。影响总生存的独立预后因素是KPS评分和颅外病灶是否控制。Background and Objective： X-ray stereotactic radiotherapy （SRT） is one of the effective treatments for brain metastases iBM）. This study was to evaluate the efficacy of SRT on BM, and investigate prognostic factors. Methods： Between July 1999 and December 2004, a total of 122 intracranial lesions in 78 patients with BM were treated using SRT in our center. Forty- nine patients had a solitary lesion and 29 had multiple （2-6） lesions. The median SRT dose was 15 Gy （11-24 Gy） in single fraction for 38 lesions, and 24 Gy （11-40 Gy） in 2-6 fractions for 84 lesions. SRT was combined with whole brain radiotherapy （WBRT） of 30-40 Gy for 39 patients. Progression-free survival （PFS） and overall survival （OS） were estimated by Kaplan-Meier method. Univariate and multivariate analyses were performed by the log-rank test and Cox model, respectively. Results： The median survival time was 12.9 months （1.7-77.4 months）. The 1-year intracranial PFS rate was 87.4%. The 1- and 2-year OS rates were 53.9% and 25.8%, respectively. Univariate analysis showed that the 1-year OS rates were significantly higher in the patients with pretreatment KPS of I〉 70, extracranial lesions controlled and SRT combined with WBRT than in those with KPS of 〈 70 （60.7% vs. 29.4%, P = 0.002）, extracranial lesions uncontrolled （69% vs. 44.9%, P = 0.005） and SRT alone （64.1% vs. 43.4%, P=0.03）. The benefit of treating with WBRT in combination was mainly achieved in patients with extracranial lesions controlled or with more than one intracranial lesion. Multivariate analysis showed that KPS score and status of extracranial lesions were independent prognostic factors for OS. Conclusions： SRT is an effective and safe modality for BM. SRT combined with WBRT may prolong the survival time for patients with extracranial lesions controlled or multiple intracranial lesions. Independent prognostic factors for QS are KPS score and status of extracranial lesions.

关 键 词：肿瘤 脑转移 疗效 预后因素 立体定向放射治疗 

分 类 号：R739.4[医药卫生—肿瘤]