伽玛刀分次立体定向放疗治疗脑转移瘤的疗效及预后分析  

Clinical outcomes of fractionated stereotactic radiotherapy for brain metastasis with gamma knife and prognostic analysis

作　　者：庞军[1] 陈浩涛[1] 陈燕[1] 李长青[1] 郝光远[2] 袁俊峰[3] 原锦[4] 

机构地区：[1]武警湖北省总队医院伽玛刀中心,湖北武汉430061 [2]武警湖北省总队医院影像科,湖北武汉430061 [3]武警湖北省总队医院神经外科,湖北武汉430061 [4]武警福建省总队医院伽玛刀中心,福建福州350003

出　　处：《肿瘤》2013年第8期723-727,共5页Tumor

摘　　要：目的:评价伽玛刀分次立体定向放射治疗(fractionated stereotactic radiotherapy,FSRT)治疗脑转移瘤的疗效,并分析预后相关因素。方法:回顾性分析2007年3月-2011年11月接受伽玛刀FSRT治疗的120例脑转移瘤患者(男性71例,女性49例)的疗效和不良反应。120例患者的中位年龄为49岁(范围:34～84岁)。FSRT中位剂量为35Gy(范围:28～45Gy),中位分割次数为7次(范围:4～10次)。中位计划靶体积为3.95cm3(0.14～25.56cm3)。对患者进行随访,中位随访时间为12个月(范围:1～50个月),随访率为97.5%。采用Kaplan-Meier法进行生存分析,log-rank检验进行预后的单因素分析,COX回归模型进行预后的多因素分析。结果:120例患者中,完全缓解63例(52.50%),部分缓解47例(39.17%)例,疾病稳定8例(6.67%),疾病进展2例(1.67%);总有效率为98.33%(118/120),6个月总的肿瘤局部控制率为96.58%(113/117)。全组患者的中位生存期为11个月(3～50个月,95%可信区间为7.8～15.6个月),1、2和3年总生存率分别为44.17%、23.60%和9.84%。多因素分析结果显示,治疗前递归分割分析评分较低和颅外病变未控是预后不良因素(P<0.05)。结论:伽玛刀FSRT治疗脑转移瘤疗效确切。治疗前递归分割分析评分较低和颅外病变未控是预后不良因素。Objective： To evaluate the efficacy and feasibility of gamma knife FSRT （fractionated stereotactic radiotherapy） with super gamma knife for BM （brain metastasis） and investigate the related prognostic factors.Methods： The complete clinical records were colleceted and retrospectively analyzed from 120 BM patients （including 71 males and 49 females） receiving gamma knife FSRT between March 2007 and November 2011.The median age was 49 （range： 34-84） years old.The median dose of FSRT was 35 （range： 28-45） Gy in 7 （range： 4-10） fractions.Median planning target volume was 3.95 （0.14-25.56） cm 3 .The patients were followed-up and the follow-up rate was 97.5% median follow-up time was 12 months （range： 1-50 months）.The Kaplan-Meier method,log-rank test and COX regression model were used for survival and prognostic analysis.Results： Of 120 patients,63 （52.50%） achieved complete response,47 （39.17%） achieved partial response,8 （6.67%） achieved stable disease,and 2 （1.67%） achieved progressive disease.The overall response rate was 98.33% （118/120）,and the six-month overall tumor control rate was 96.58% （113/117）.The median survival time was 11 months （range： 3-50 months; 95% confidence interval： 7.8-15.6）.The 1-,2- and 3-year overall survival rates were 44.17%,23.60% and 9.84%,respectively.The multivariate analysis showed that RPA （recursive partitioning analysis） class and extracranial lesion status were independent prognostic factors （P〈0.05）.Conclusion： The patientswith BM have a good response to Gamma knife FSRT,and the side effects are tolerable.RPA class and extracranial lesion status are independent prognostic factors for BM patinets receiving gamma knife FSRT.

关 键 词：脑转移瘤 分次立体定向放射治疗 伽玛刀 预后 

分 类 号：R730.55[医药卫生—肿瘤]