小细胞肺癌脑转移全脑放疗失败后挽救性分次立体定向放疗疗效分析  

Fractionated stereotactic radiotherapy for recurrent small cell lung cancer brain metastases after whole brain radiotherapy

作　　者：李祥攀[1] 肖建平[1] 陈秀军[1] 姜雪松[1] 张烨[1] 徐英杰[1] 郇福奎[1] 方浩[1] 万宝[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20-22,共3页Chinese Journal of Radiation Oncology

基　　金：北京希望马拉松专项基金（LC2008A03）

摘　　要：目的评价小细胞肺癌（SCLC）全脑放疗（WBRT）后颅内失败分次立体定向放疗（FSRT）挽救的价值。方法回顾分析WBRT失败后使用FSRT挽救的35例SCLC脑转移患者的生存情况，多因素分析确定和生存相关的预后因素。结果随访率为100％，中位随访时间11个月。全组总中位生存期为10．3个月，多因素分析显示颅外疾病控制状态和患者的生存相关（X^2=4．02，P=0．045）。自诊断脑转移开始中位生存期为22．0个月，未发现严重晚期不良反应。6、12个月局部控制率分别为91％、76％。6例局部未控患者中3例行二程FSRT挽救，挽救治疗后生存时间分别为3、9、13个月。6例患者FSRT后出现治疗野外新病灶，出现新病灶中位时间为4个月。32例患者死亡，其中14例死于颅内进展，14例死于颅外疾病进展，1例死于脑脊髓膜广泛转移，3例死于其他原因（2例肺部感染，1例死因不明）。结论FSRT挽救治疗对WBRT后复发SCLC脑转移安全有效。Objective Evaluation the Fractionated Stereotactic Radiotherapy （FSRT） for the patients with small-cell lung cancer （SCLC） after the whole brain radiotherapy （WBRT） failure. Methods We retrospectively analyzed 35 patients with brain metastases from small-cell lung cancer treated with linear accelerator FSRT after the WBRT failure. Multivariate analysis was used to determine significant prognostic factor related to survival. Results The following-up rate was 100%. The median following-up time was 11 months. The median over-all survival （OS） time was 10. 3 （1 -30） months after FSRT. Controlled extra cranial disease was the only identified significant predictor of increased median OS time （X2 =4. 02, P= 0. 045）. The median OS time from the diagnosis of brain metastasis was 22 （6 -134） months. 14 patients died from brain metastasis, 14 from extra-cranial progression, 1 from leptomeningeal metastases, and 3 from other causes. Local control at 6 months and 12 months was 91% and 76% , respectively. No significant late complications. New brain metastases outside of the treated area developed im 17% of patients at a median time of 4 （2 - 20 ） months; all patients had received previous WBRT. Conclusions Fractionated stereotactic radiotherapy was safe and effective treatment for recurrent small-ceil lung carcinoma brain metastases.

关 键 词：癌 小细胞肺 肿瘤转移 脑 放射疗法 立体定向 

分 类 号：R734.2[医药卫生—肿瘤]