非小细胞肺癌局限性脑转移患者不同放疗方式的临床疗效评价  

Clinical evaluation of different radiotherapy modalities in patients with limited intracranial metastases and non-small cell lung cancer

作　　者：毛明玉 杨柳[1] 张妮 欧海斌 刘羽[1] MAO Mingyu;YANG Liu;ZHANG Ni;OU Haibin;LIU Yu(Dept.of Radiation and Medical Oncology,Zhongnan Hospital of Wuhan University,Hubei Key Laboratory of Tumor Biological Behaviors,Hubei Cancer Clinical Study Center,&Hubei Cancer Radiation Therapy Quality Control Center,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院放化疗科/湖北省肿瘤生物学行为重点实验室/湖北省肿瘤医学临床研究中心/湖北省肿瘤放射治疗质量控制中心,湖北北武汉430071

出　　处：《武汉大学学报（医学版）》2024年第4期413-419,共7页Medical Journal of Wuhan University

基　　金：国家自然科学基金项目(编号:81370070、8217103238);武汉大学中南医院科技创新培育基金(编号:cxpy2017027);武汉大学中南医院医学科技创新平台支撑项目(编号:PTXM2019030)。

摘　　要：目的:探讨全脑放疗(WBRT)、立体定向放射外科(SRS)在治疗非小细胞肺癌(NSCLC)局限性脑转移患者的临床疗效。方法:回顾性分析近4年来武汉大学中南医院肿瘤放化疗科91例NSCLC局限性脑转移患者的临床资料。依据不同放疗方式,将其分为WBRT+SRS、WBRT、SRS组。对3组患者治疗疗效进行比较,分析不同放疗方式对NSCLC局限性脑转移患者总体生存时间(OS)及颅内局控时间(IPFS)的影响。结果:共纳入患者91例,其中WBRT+SRS组10人,WBRT组55人,SRS组26人,中位随访时间13个月。各组中位OS依次为17.5、16.0、12.5个月,组间脑部放疗后OS无显著差异(P=0.492);各组中位IPFS依次为11.5、7、6个月,WBRT+SRS组较WBRT、SRS组显著延长(P=0.034)。多因素分析显示,颅外病灶控制情况、全身治疗方式(靶向治疗、化学治疗)是影响OS的主要预后因素;放疗方式是影响IPFS的主要预后因素。结论:WBRT联合SRS对NSCLC局限性脑转移患者颅内病情的控制有较好的疗效,但WBRT+SRS、WBRT、SRS组间无显著生存差异。颅外病灶控制情况、全身治疗方式是影响生存的主要预后因素。Objective:To evaluate the efficacy of stereotactic radiosurgery(SRS)in comparison with whole brain radiation(WBRT)and assess treatment outcomes following them in patients with limited intra-cranial metastases and non-small cell lung cancer.Methods:A retrospective analysis of patients treat-ed for brain metastases with different irradiation modalities was performed.Local control(LC)and clinical outcomes were evaluated with magnetic resonance imaging.Patients were divided into WBRT+SRS,WBRT-alone,and SRS-alone groups according to different radiotherapy modalities,and their effects on overall survival(OS)and intracranial progression-free survival(IPFS)of patients with NSCLC-localized brain metastases were analyzed.Results:A total of 91 patients were enrolled in the analysis(10 patients in the WBRT+SRS,55 patients in the WBRT,and 26 patients in the SRS)with a median follow-up of 13 months.The median OS following brain irradiation for WBRT+SRS,WBRT,and SRS were qualitatively different(17,16,and 12.5 months,respectively),al-though the difference was not statistically significant.The median IPFS in the three groups was 11.5,7,and 6 months,respectively,and the WBRT+SRS group had longer IPFS as compared with the WBRT-alone and SRS-alone groups(P=0.034).Further multivariate analysis showed that control of extracranial lesions and systemic treatment(targeted therapy and chemotherapy)were the main prog-nostic factors affecting OS.The factors affecting IPFS were mainly related to radiotherapy.Conclusion:The results suggested that WBRT+SRS has favorable local control compared with WBRT alone and SRS alone.However,there was no significant difference in survival between the groups.Control of extracranial lesions and systemic treatment were the major prognostic factors.

关 键 词：非小细胞肺癌 脑转移瘤 全脑放疗 立体定向放射治疗 联合治疗 

分 类 号：R734.2[医药卫生—肿瘤]