肺癌脑转移瘤的不同伽玛刀治疗方式近期疗效观察  

Short-term outcomes of different gamma knife stereotactic radiotherapy treatments for brain metastases from lung cancer

作　　者：胡凯[1] 方萍[1] 单娟[1] 韩卫[1] 刘林龙 丁涤非[1] 

机构地区：[1]解放军第123医院肿瘤科,安徽省蚌埠市233015

出　　处：《中华全科医学》2015年第10期1603-1605,共3页Chinese Journal of General Practice

摘　　要：目的 对比研究伽玛刀单次与分次治疗肺癌脑转移瘤的疗效及影响疗效的临床因素.方法 分析2011年8月-2012年8月所收治的肺癌脑转移瘤患者60例（脑转移病灶≤3个且肿瘤直径≤4 cm）,随机分成2组：伽玛刀单次治疗组30例和分次治疗组30例.40％～60％等剂量线包绕整个靶区,单次伽玛刀治疗剂量为16～25Gy,分次伽玛刀治疗单次周边剂量为3～5Gy,总剂量为35～45Gy.通过治疗后3个月时采用RECIST实体瘤疗效判定标准来评价肺癌脑转移瘤治疗的近期疗效,采用x2检验分析其影响因素和近期疗效的关系.结果 肺癌脑转移瘤的伽玛刀单次治疗组及分次治疗组3个月后肿瘤局控率分别为66.7％、73.3％.转移瘤数目为1个者局控率明显高于转移瘤数目为2～3个（P=0.0127）.KPS评分≥70的患者局控率明显高于KPS评分＜70的患者（P =0.0136）.处方剂量线≥50％的患者局控率明显高于处方剂量线＜50％的患者（P=0.0007）.根据RTOG评定标准有43例发生了Ⅰ～Ⅱ级的中枢神经系统急性放疗反应,均经处理后好转.结论 不论是单次治疗还是分次治疗,伽玛刀治疗是肺癌脑转移瘤患者的有效手段,且不良反应轻,但单次治疗在放疗时间上比分次治疗占优势.Objective To evaluate the efficacy of gamma knife stereotactic radiotherapy single treatment or fractionated treatment for patients with brain metastases from tung cancer and the clinical factors influencing the prognosis of these patients. Methods 60 patients from August 2011 to August 2012.8 （ brain metastases ≤ 3 and tumor diameter ≤4 cm） were randomly divided into two groups. 30 patients received single treatment and the others received fractionated treatment. The radiosurgery plan was designed to cover whole target area at isodose curves of 40% -60% with a margin dose of 16 -25 Gy once or the margin dose of 3 - 5 Gy each time, the total margin dose of 35 - 45 Gy. Therapeutic effect at 3 months after radiosurgery was evaluated by RECIST solid tumor evaluation criteria, and then, chi-square test analysis was employed to define the relationship between the early therapeutic effect and factors. Results The local control rate was 66.7% and 73.3 % for single treatment and fractionated treatment within 3 months, respectively. The local control rate of patients with number of metastases only one was siguificanfly higher than that of patients with more than 2 metastases （P = 0.0127）. The local control rate of patients with KPS grade ≥ 70 was significantly higher than that of patients with KPS grade ≥ 70 （P = 0.0136）. The local control rate of patients with Line prescription dose ≥50% was significantly higher than that of patients with Line prescription dose 〈 50% （P = 0.0007 ）. According to RTOG evaluation standard of 43 cases of acute radiation response of CNS Ⅰ - Ⅱ ,were treated better. Conclusion Whether it is single or fractionated in the treatment of brain metastases from lung cancer, gamma knife stereotactic radiotherapy is an efficacious methods, and with less radio- therapy-induced side effects, but the single treatment may possess a shorter time.

关 键 词：伽玛刀 肺癌 脑转移瘤 

分 类 号：R734.2[医药卫生—肿瘤] R739.41[医药卫生—临床医学]