立体定向放疗与全脑放疗在多发脑转移瘤治疗中的作用分析  

The role of stereotactic radiation therapy and whole.brain radiotherapy in the treatment of multiple brain metastases

作　　者：陈秀军[1] 肖建平[1] 李祥攀[1] 姜雪松[1] 张烨[1] 徐英杰[1] 戴建荣[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》2012年第1期1-5,共5页Chinese Journal of Radiation Oncology

基　　金：北京希望马拉松专项基金（LC2008A03）

摘　　要：目的总结立体定向放疗（SRT）加或不加全脑放疗（WBRT）治疗多发脑转移瘤的结果，探讨WBRT和SRT在多发脑转移瘤治疗中的作用。方法1995--2010年收治的98例新诊断的多发（2-13个病灶）脑转移瘤患者。单纯SRT44例，WBRT加SRT54例。剂量分割模式依据转移瘤部位、体积及是否WBRT。用Kaplan-Meier法计算生存率，Cox回归模型进行各因素预后分析。中位生存期（MST）为从脑转移瘤放疗开始至各种原因所致死亡的时间的中位数。结果全组患者中位随访时间12个月，随访率为100％。全组MST为13．5个月，其中SRT组、WBRT加SRT组的分别为13．0、13．5个月（X^2=O．31，P=0．578）。多因素分析显示仅卡氏评分（X^2=6．25，P=0．012）、原发灶诊断及脑转移瘤诊断问隔时间（X^2=7．34，P=0．025）和颅外病变情况（X^2=4．20，P=0．040）是预后因素。结论SRT是多发脑转移瘤患者有效治疗手段，单纯SRT可取得与WBRT加SRT相似的生存期。首程SRT可能是多发脑转移瘤患者的另一治疗选择。Objective To summarize the results of stereotactic radiation therapy （SRT） with or without whole-brain radiotherapy （WBRT） in the treatment of muhiple brain metastasis. Methods From May 1995 to April 2010, totally 98 newly diagnosed multiple （2 - 13 lesions） brain metastases patients were treated in our centre. Forty-four patients were treated with SRT alone and 54 with SRT ＋ WBRT. Dose fractionation schemes were 15 - 26 Gy in 1 fraction or 24. 0 - 52. 5 Gy in 2 - 15 fractions with 3.5 - 12.0 Gy per fraction, depending on the tumor volume, location, and history of prior irradiation. Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis. The median age of the whole group was 55 years. The survival time was calculated from the date of radiation treatment to the day of death by any cause. Results The median follow-up time for the whole group was 12 months, and the fallow-up rate was 100%. The median overall survival time was 13.5 months for the whole group, there was no difference between SRT alone group and SRT ＋ WBRT group （ 13.0 months vs. 13.5 mouths, X2 = 0. 31, P = 0. 578 ）. The Karnofsky Performance Score （KPS） at the time of treatment （ X2 = 6. 25, P = 0. 012）, the interval between the diagnosis of the primary tumor and brain metastases （ X2 -- 7. 34, P = 0. 025 ） and the status of extracranial metastases （ X2 = 4. 20, P = O. 040 ） were independent prognosis factors for survival in multivariate analyses. Conclusions Stereotactic radiation therapy is an effective and alternative treatment choice for multiple brain metastases.

关 键 词：肿瘤转移 脑/全脑放射疗法 肿瘤转移 脑/立体定向放射疗法 预后 

分 类 号：R734.2[医药卫生—肿瘤]