局部增量照射无益于全患者生存再提高脑照射SCLC脑转移  

Radiation boost does not help whole-brain radiotherapy further improve survivals of SCLC brain metastasis patients

作　　者：李振生[1] 申东星 申晓菲 段学娟 张钧[1] Li Zhensheng;Shen Dongxing;Shen Xiaofei;Duan Xuejuan;Zhang Jun(Department of Radiation Oncology , Fourth Hospital of Hebei Medical University, Shifiazhuang 050035, Chin)

机构地区：[1]河北医科大学第四医院放疗科,石家庄050035

出　　处：《中华放射肿瘤学杂志》2018年第6期553-558,共6页Chinese Journal of Radiation Oncology

摘　　要：目的 探讨局部增量照射（Boost）能否提高WBRT对小细胞肺癌脑转移（SCLC-BM）患者的OS和无颅内进展生存。方法 回顾分析2013—2015年首次诊治SCLC-BM 166例。除外PCI史（16例）或SRT （10例）或单纯局部脑照射（1例）,入组142例。利用Kaplan-Meier法计算生存率Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 平均年龄59.6岁,女性23%,脑转移灶数目分别为1（35%）、2～3（23%）、≥4（42%）,化疗70%。中位OS期9.0个月、无颅内进展生存7.3个月。无照射（53例）、单纯WBRT （33）和WBRT＋Boost （56）累计死亡率依次为92%、79%和73%;累计失败（死亡或颅内病灶未控）率为94%、82%和80%;与无照射相比,以上放疗模式对OS有影响（P=0.000、0.000）,无颅内进展生存也有影响（P=0.000、0.000）。与单纯WBRT相比,WBRT＋Boost对OS无影响（P=0.41、0.51）。结论 WBRT提高SCLC脑转移患者OS和无颅内进展生存,但同期或后续Boost照射无益于再提高生存。Objective To investigate the effect of radiation boost （Boost） on further improving overall survival （OS） and intracranial progression-free survival （IPFS） of small-cell lung cancer （SCLC） brain metastases （BM） patients treated by whole-brain radiotherapy （WBRT）. Methods A retrospective analysis of 142 consecutive SCLC BM patients admitted between 2013 and 2015 was conducted after excluding those with historical prophylactic cranial irradiation （n=16） or SRT （n=10） or local RT alone （n=1）.The Kaplan-Meier curve was utilized to calculate the survival rate. The log-rank test and multivariate Cox proportional hazard regression model were utilized to evaluate clinical prognosis. Results All patients were aged 59.6 years old on average, and the female proportion was 23%. The quantity of brain metastasis lesion was 1 in 35%, 2-3 in 23% and ≥4 in 42%, respectively. The proportion of patients receiving chemotherapy was 70%. The median OS was 9.0 months and the median IPFS was 7.3 months. The accumulative mortality rate in the non-radiation （n=53）, WBRT （n=33） and WBRT＋ Boost （n=56） groups was 92%, 79% and 73%, and the accumulative failure rate （death or new/relapsed brain metastasis） was 94%, 82% and 80%, respectively. Compared with the non-radiation group, WBRT and WBRT＋ Boost therapies exerted significant effect upon OS （P=0.000 and 0.000） and IPFS （P=0.000 and 0.000）. Compared with WBRT alone, WBRT＋ Boost treatment exerted no significant effect upon OS （P=0.41 and 0.51）. Conclusions WBRT can significantly improve OS and IPFS of patients with SCLC-BM. However, concurrent and additional radiation boost does not further improve the survival rate.

关 键 词：脑转移 小细胞肺癌/全脑放射疗法 预后 

分 类 号：R730.55[医药卫生—肿瘤] R734.2[医药卫生—临床医学]